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Myers NL, Wilkey J, Chacon M, Hutnyan M, Janssen C, Tarvin H, Cohen D, Holmes I, Klodnick VV, Mihiret MA, Reznik SJ, Shimizu TK, Stein E, Lopez MA. Perspectives of young adults diagnosed with early psychosis using coordinated specialty care in Texas on substance use and substance use interventions. Early Interv Psychiatry 2023:10.1111/eip.13488. [PMID: 38030586 PMCID: PMC11133765 DOI: 10.1111/eip.13488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/29/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023]
Abstract
AIM Despite known prevalence of substance use (SU) among young people experiencing early psychosis and increasing evidence for the relationship between certain substances (e.g., cannabis) and psychosis, there are no specialized interventions developed for effectively addressing substance use among young people participating in coordinated early psychosis services. This study elicited the perspectives of young people with early psychosis participating in Coordinated Specialty Care (CSC) programs about their substance use, including their motivations and concerns around their use, and their ideas on how to best support young people who are interested in reducing or quitting substance use. METHODS We recruited young adults (ages 18 to 30) from CSC programs across Texas through flyers sent to program staff inviting young persons willing to talk about substance use to engage in a 60-90 min person-centered, semi-structured, audio-recorded Zoom interview. RESULTS A total of 22 young adults were recruited and 18 completed an interview. Participants described mixed positive and negative responses to substance use, and while many understood the importance of discontinuing substance use, many expressed ambivalence related to social, contextual, mental and physical factors that motivated them to keep using. Participants desired practical substance use information, opportunities to explore their substance use ambivalence in supportive relationships, positive peer communities to support healthy choices, help engage, with work, school, and hobbies, and strategies for addressing psychological and physical pain that did not include substance use. CONCLUSION Study findings illuminate what motivates young people with early psychosis to initiate, continue, or cut back on substance use, and ideas for CSC practices for exploring substances and helping young people to reduce substance use.
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Affiliation(s)
- Neely Laurenzo Myers
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Justin Wilkey
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Marne Chacon
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Matthew Hutnyan
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Claire Janssen
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Halle Tarvin
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Deborah Cohen
- The University of Texas at Austin, Steve Hicks School of Social Work, Texas Institute for Excellence in Mental Health, Austin, Texas, USA
| | - Imani Holmes
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Vanessa Vorhies Klodnick
- The University of Texas at Austin, Steve Hicks School of Social Work, Texas Institute for Excellence in Mental Health, Austin, Texas, USA
| | - Mesganaw A Mihiret
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Samantha J Reznik
- The University of Texas at Austin, Steve Hicks School of Social Work, Texas Institute for Excellence in Mental Health, Austin, Texas, USA
| | | | - Emily Stein
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Molly A Lopez
- The University of Texas at Austin, Steve Hicks School of Social Work, Texas Institute for Excellence in Mental Health, Austin, Texas, USA
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Wilson M, Harris M, Pereira M, Buckle J, Forshall E, Murphy T, Thompson A, Kavanagh G, Whale R. Predictors of hospitalisation and recovery following full antipsychotic discontinuation in first episode psychosis. A naturalistic retrospective cohort study. Schizophr Res 2023; 261:269-274. [PMID: 37862826 DOI: 10.1016/j.schres.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 05/30/2023] [Accepted: 10/09/2023] [Indexed: 10/22/2023]
Abstract
Whilst antipsychotic medication reduces risk of relapse following a first episode of psychosis (FEP), some individuals can discontinue medication and remain relapse free. We aimed to identify patient and service-specific factors which influence clinical outcome following antipsychotic discontinuation. The outcomes 'admission to hospital' and 'remaining free from psychotic symptoms', both within one year from discontinuation, were explored retrospectively in an established naturalistic cohort of 354 patients with FEP. Logistic regression analysis was used to explore influence of routinely available baseline and treatment course variables on these outcomes. Seventy-seven individuals (22 %) fully discontinued antipsychotic treatment within a year, at mean 102 days from initiation. Only antipsychotic type had significant association with discontinuation; aripiprazole was discontinued more than olanzapine (p = 0.028). Seventeen individuals required admission to hospital; significantly associated with prior admission at first illness onset (p = 0.004), and prior legal detention to hospital (p = 0.001). Admission was less likely in those discontinuing aripiprazole vs olanzapine (p = 0.044). Twenty-four patients remained psychosis symptom free and were most significantly likely to have received clinician support in discontinuation; this group had no association with either initial duration of untreated psychosis or prior duration of antipsychotic treatment. Future studies exploring outcomes following antipsychotic discontinuation require consistency of choice of outcome measures and sample stratification by vulnerability factors including severity of first illness episode, whether remaining symptom free after first episode, which medication switched from and baseline functioning. The impact and nature of clinician support to discontinue requires further exploration alongside its association with abruptness of discontinuation.
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Affiliation(s)
| | | | - Marco Pereira
- University of Coimbra, Faculty of Psychology and Educational Sciences, Portugal
| | | | | | | | | | | | - Richard Whale
- Brighton and Sussex Medical School, UK; Sussex Partnership NHS Foundation Trust, UK.
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Casanovas F, Fonseca F, Mané A. Substance use Specificities in Women with Psychosis: A Critical Review. Curr Neuropharmacol 2023; 21:1953-1963. [PMID: 36453494 PMCID: PMC10514534 DOI: 10.2174/1570159x21666221129113942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/28/2022] [Accepted: 09/03/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Women with schizophrenia or other psychotic disorders differ from male patients in many respects, including psychopathology, prognosis, disease course, and substance use comorbidities. Most studies performed to date to investigate the association between drug use and psychosis have not evaluated gender differences, although this has started to change in recent years. METHODS We briefly summarize the available evidence on gender differences in drug use and substance use disorders (SUD) in psychotic patients during the early phases of the psychotic illness and during the course of schizophrenia. RESULTS Substance use and SUD are both less prevalent in women, both in the general population and at all phases of the psychotic spectrum. Some studies suggest that SUD may be under diagnosed in female patients, in part due to their more vulnerable profile. Substance use, especially cannabis, may more negatively impact females, especially on the disease course and prognosis. The available data suggest that it may be more difficult to treat SUD in female patients with schizophrenia, which could negatively impact prognosis. CONCLUSION Women with concomitant psychotic illness and SUD comprise a highly vulnerable subgroup. This should be considered when selecting the treatment approach, especially in the early phases of the illness, to ensure better outcomes.
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Affiliation(s)
- Francesc Casanovas
- Institut de Neuropsiquiatria i Adiccions (INAD), Parc de Salut Mar, Barcelona, Spain
| | - Francina Fonseca
- Institut de Neuropsiquiatria i Adiccions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra, Barcelona, Spain
| | - Anna Mané
- Institut de Neuropsiquiatria i Adiccions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra, Barcelona, Spain
- Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Madrid, Spain
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Vava Y, Koen L, Niehaus D, Botha HF, Botha U. Impact of completing a psychosocial rehabilitation programme on inpatient service utilisation in South Africa. S Afr J Psychiatr 2022; 28:1764. [PMID: 36340642 PMCID: PMC9634828 DOI: 10.4102/sajpsychiatry.v28i0.1764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 06/14/2022] [Indexed: 11/06/2022] Open
Abstract
Background Deinstitutionalisation refers to the process of transferring most of the psychiatric care provision from inpatient state-run institutions to community-based care. However, it has proven difficult to implement and failed to reach its desired targets. New Beginnings (NB) is a transitional care facility that facilitates the transition from in- to outpatient care. To date, no data exist as to whether the intervention provided at NB is effective in reducing psychiatric readmissions. Aim To determine if completing a psychosocial rehabilitation (PSR) programme reduces acute inpatient service utilisation and if this is influenced by sociodemographic or clinic factors. Setting New Beginnings transitional care facility in South Africa. Methods A record review of all NB admissions between January 2011 and December 2015. Demographic and clinical data were collected, including readmissions and days-in-hospital (DIH), 36 months pre- and postindex admission. Patients were divided into a completer group (CG) and a noncompleter group (NCG) for the eight-week PSR programme, and comparative statistical analysis was performed. Results Completion of the 8-week voluntary inpatient PSR programme led to a significant decrease (p = 0.017) (CG vs. NCG) in DIH during the 36-month period postindex admission. In addition, both groups showed significantly decreased (p < 0.001) DIH postindex in comparison to pre-index admission. Conclusions This study’s findings support that transitional care facilities offering an inpatient PSR programme may reduce inpatient service utilisation for all attendees but especially for those who complete the program. This highlights the need for such facilities that offer interventions tailored for patients with mental illness. Contribution This is the first local study highlighting the potentially important role transitional care facilities could play in reducing readmissions.
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Affiliation(s)
- Yanga Vava
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Liezl Koen
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Dana Niehaus
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Henmar F. Botha
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ulla Botha
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Clinical and treatment predictors of relapse during a three-year follow-up of a cohort of first episodes of schizophrenia. Schizophr Res 2022; 243:32-42. [PMID: 35231832 DOI: 10.1016/j.schres.2022.02.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/24/2021] [Accepted: 02/17/2022] [Indexed: 12/13/2022]
Abstract
Relapses are frequent in the first years following a first episode of schizophrenia (FES), being associated with a higher risk of developing a chronic psychotic disorder, and poor clinical and functional outcomes. The identification and intervention over factors associated with relapses in these early phases are timely and relevant. In this study, 119 patients in remission after a FES were closely followed over three years. Participants came from the 2EPS Project, a coordinated, naturalistic, longitudinal study of 15 tertiary centers in Spain. Sociodemographic, clinical, treatment and substance abuse data were analyzed. 49.6% of the participants relapsed during the 3-years follow-up. None of the baseline demographic and clinical characteristics analyzed showed a statistically significant association with relapses. 22% of patients that finished the follow-up without relapsing were not taking any antipsychotic. The group that relapsed presented higher mean antipsychotics doses (381.93 vs. 242.29 mg of chlorpromazine equivalent/day, p = 0.028) and higher rates of antipsychotic polytherapy (28.6% vs. 13%, p < 0.001), benzodiazepines use (30.8% vs. 8.5%, p < 0.001), side effects reports (39.2% vs. 25%, p = 0.022), psychological treatment (51.8% vs. 33.9%, p = 0.03), and cannabis consumption (93.2% vs. 56.7%, p < 0.001). Clozapine use was notably higher in the group that reminded in remission (21.7% vs. 8.2%, p < 0.019). These findings may guide clinicians to detect subgroups of patients with higher risk to present a second episode of psychosis, focusing on measures to ensure an adequate treatment or facilitating cannabis use cessation. This study supports future research to identify relapse prevention strategies for patients in early phases of schizophrenia.
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Jørgensen KT, Bøg M, Kabra M, Simonsen J, Adair M, Jönsson L. Predicting time to relapse in patients with schizophrenia according to patients' relapse history: a historical cohort study using real-world data in Sweden. BMC Psychiatry 2021; 21:634. [PMID: 34933680 PMCID: PMC8690369 DOI: 10.1186/s12888-021-03634-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For patients with schizophrenia, relapse is a recurring feature of disease progression, often resulting in substantial negative impacts for the individual. Although a patient's relapse history (specifically the number of prior relapses) has been identified as a strong risk factor for future relapse, this relationship has not yet been meticulously quantified. The objective of this study was to use real-world data from Sweden to quantify the relationship of time to relapse in schizophrenia with a patient's history of prior relapses. METHODS Data from the Swedish National Patient Register and Swedish Prescribed Drug Register were used to study relapse in patients with schizophrenia with a first diagnosis recorded from 2006-2015, using proxy definitions of relapse. The primary proxy defined relapse as a psychiatric hospitalisation of ≥7 days' duration. Hazard ratios (HRs) were calculated for risk of each subsequent relapse, and Aalen-Johansen estimators were used to estimate time to next relapse. RESULTS 2,994 patients were included, and 5,820 relapse episodes were identified using the primary proxy. As the number of previous relapses increased, there was a general trend of decreasing estimated time between relapses. Within 1.52 years of follow-up, 50% of patients with no history of relapse were estimated to have suffered their first relapse episode. 50% of patients with one prior relapse were estimated to have a second relapse within 1.23 years (HR: 1.84 [1.71-1.99]) and time to next relapse further decreased to 0.89 years (HR: 2.77 [2.53-3.03]) and 0.22 years (HR: 18.65 [15.42-22.56]) for 50% of patients with two or ten prior relapses, respectively. Supplementary analyses using different inclusion/exclusion criteria for the study population and redefined proxies of relapse reflected the pattern observed with the primary analyses of a higher number of prior relapses linked with increased risk of/reduced estimated time to the next relapse. CONCLUSIONS The results suggested a trend of accelerating disease progression in schizophrenia, each relapse episode predisposing an individual to the next within a shorter time period. These results emphasise the importance of providing early, effective, and tolerable treatments that better meet a patient's individual needs.
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Affiliation(s)
| | - Martin Bøg
- H. Lundbeck A/S, Ottiliavej 9, 2500, Valby, Denmark
| | - Madhu Kabra
- Otsuka Pharmaceutical Europe Ltd., Wexham, UK
| | | | - Michael Adair
- H. Lundbeck A/S, Ottiliavej 9, 2500, Valby, Denmark.
| | - Linus Jönsson
- H. Lundbeck A/S, Ottiliavej 9, 2500, Valby, Denmark.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
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7
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Lal S, Gleeson JF, D'Alfonso S, Etienne G, Joober R, Lepage M, Lee H, Alvarez-Jimenez M. A Digital Health Innovation to Prevent Relapse and Support Recovery in Youth Receiving Specialized Services for First-Episode Psychosis: Protocol for a Pilot Pre-Post, Mixed Methods Study of Horyzons-Canada (Phase 2). JMIR Res Protoc 2021; 10:e28141. [PMID: 34879000 PMCID: PMC8693205 DOI: 10.2196/28141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 08/18/2021] [Accepted: 09/07/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Psychotic disorders are among the most disabling of all mental disorders. The first-episode psychosis (FEP) often occurs during adolescence or young adulthood. Young people experiencing FEP often face multiple barriers in accessing a comprehensive range of psychosocial services, which have predominantly been delivered in person. New models of service delivery that are accessible, sustainable, and engaging are needed to support recovery in youth diagnosed with FEP. OBJECTIVE In this paper, we describe a protocol to implement and evaluate the acceptability, safety, and potential efficacy of an online psychosocial therapeutic intervention designed to sustain recovery and prevent relapses in young adults diagnosed with FEP. This intervention was originally developed and tested in Australia and has been adapted for implementation and evaluation in Canada and is called Horyzons-Canada (HoryzonsCa). METHODS This cohort study is implemented in a single-center and applies a pre-post mixed methods (qualitative-quantitative convergent) design. The study involves recruiting 20 participants from a specialized early intervention program for psychosis located in Montreal, Canada and providing them with access to the HoryzonsCa intervention for 8 weeks. Data collection includes interview-based psychometric measures, self-reports, focus groups, and interviews. RESULTS This study received funding from the Brain and Behavior Research Foundation (United States), the Quebec Health Research Funding Agency (Canada), and the Canada Research Chairs Program. The study was approved by the Research Ethics Board of the Centre intégré universitaire de santé et de services sociaux de l'Ouest-de-l'Île-de-Montréal on April 11, 2018 (#IUSMD 17-54). Data were collected from August 16, 2018, to April 29, 2019, and a final sample of 20 individuals participated in the baseline and follow-up interviews, among which 9 participated in the focus groups. Data analysis and reporting are in process. The results of the study will be submitted for publication in 2021. CONCLUSIONS This study will provide preliminary evidence on the acceptability, safety, and potential efficacy of using a digital health innovation adapted for the Canadian context to deliver specialized mental health services to youth diagnosed with FEP. TRIAL REGISTRATION ISRCTN Registry ISRCTN43182105; https://www.isrctn.com/ISRCTN43182105. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/28141.
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Affiliation(s)
- Shalini Lal
- School of Rehabilitation, Faculty of Medicine, University of Montréal, Montréal, QC, Canada
- Youth Mental Health and Technology Lab, Health Innovation and Evaluation Hub, University of Montréal Hospital Research Centre, Montréal, QC, Canada
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, QC, Canada
- ACCESS Open Minds, Douglas Mental Health University Institute, Montréal, QC, Canada
| | - John F Gleeson
- Healthy Brain and Mind Research Centre and School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Australia
| | - Simon D'Alfonso
- School of Computing and Information Systems, University of Melbourne, Parkville, Australia
| | - Geraldine Etienne
- ACCESS Open Minds, Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, QC, Canada
- ACCESS Open Minds, Douglas Mental Health University Institute, Montréal, QC, Canada
- Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Martin Lepage
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, QC, Canada
- Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Hajin Lee
- School of Rehabilitation, Faculty of Medicine, University of Montréal, Montréal, QC, Canada
- Youth Mental Health and Technology Lab, Health Innovation and Evaluation Hub, University of Montréal Hospital Research Centre, Montréal, QC, Canada
| | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
- Orygen, Parkville, Australia
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Bernardo M, Amoretti S, Cuesta MJ, Parellada M, Mezquida G, González-Pinto A, Bergé D, Lobo A, Aguilar EJ, Usall J, Corripio I, Bobes J, Rodríguez-Jiménez R, Sarró S, Contreras F, Ibáñez Á, Gutiérrez M, Micó JA. The prevention of relapses in first episodes of schizophrenia: The 2EPs Project, background, rationale and study design. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2021; 14:164-176. [PMID: 34456031 DOI: 10.1016/j.rpsmen.2021.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/15/2020] [Indexed: 12/16/2022]
Abstract
Up to 80% of first-episode psychosis patients suffer a relapse within five years of the remission. Relapse should be an important focus of prevention given the potential harm to the patient and family. It threatens to disrupt their psychosocial recovery, increases the risk of resistance to treatment and has been associated with greater direct and indirect costs for society. Based on a previous project entitled "Genotype-phenotype and environment. Application to a predictive model in first psychotic episodes" (PEPs Project), the project "Clinical and neurobiological determinants of second episodes of schizophrenia. Longitudinal study of first episode of psychosis" was designed, also known as the 2EPs Project. It aimed to identify and characterize those factors that predict a relapse within the years immediately following a first episode. This project has focused on following the clinical course, with neuropsychological assessments, biological and neuroanatomical measures, genetic adherence and physical health monitoring in order to compare a subgroup of patients with a second episode to another group of patients which remains in remission. The main objective of the present article is to describe the rationale of the 2EPs Project, explaining the measurement approach adopted and providing an overview of the selected clinical and functional measures. 2EPs Project is a multicenter, coordinated, naturalistic, longitudinal follow-up study over three years in a Spanish sample of patients in remission after a first-psychotic episode of schizophrenia. It is closely monitoring the clinical course of the cases recruited to compare the subgroup of patients with a second episode to that which remains in remission. The sample is composed of 223 subjects recruited from 15 clinical centres in Spain with experience of the preceding PEPs Study project, albeit 2EPs being an expanded version with new basic groups in biological research. From the total sample recruited, 63 patients presented a relapse (44%). 2EPs arose to characterize first episodes in an exhaustive, novel and multimodal way, thus contributing towards the development of a predictive model of relapse. Identifying the characteristics of patients who relapse could improve early detection and intervention.
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Affiliation(s)
- Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain; Departament de Medicina, Institut de Neurociències, Universitat de Barcelona, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
| | - Silvia Amoretti
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain; Departament de Medicina, Institut de Neurociències, Universitat de Barcelona, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Manuel Jesús Cuesta
- Departamento de Psiquiatría, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain
| | - Mara Parellada
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Servicio de Psiquiatría del Niño y del Adolescente, Hospital General Universitario Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, CIBERSAM, Madrid, España
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain; Departament de Medicina, Institut de Neurociències, Universitat de Barcelona, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Ana González-Pinto
- Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Department of Neurociences, University of the Basque Country, CIBERSAM, Vitoria, Spain
| | - Daniel Bergé
- Department of Neurosciences and Psychiatry, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Antonio Lobo
- Department of Medicine and Psychiatry. Universidad de Zaragoza. Instituto de Investigación Aragón, CIBERSAM, Zaragoza, Spain
| | - Eduardo J Aguilar
- Department of Psychiatry, Hospital Clínico Universitario de Valencia, School of Medicine, Universidad de Valencia, CIBERSAM, Valencia, Spain
| | - Judith Usall
- Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, SantBoi de Llobregat; Fundació Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Iluminada Corripio
- Department of Psychiatry, Biomedical Research Institute Sant Pau (IIB-SANT PAU), Santa Creu and Sant Pau Hospital; Autonomous University of Barcelona (UAB), CIBERSAM, Barcelona, Spain
| | - Julio Bobes
- Área de Psiquiatría, Universidad de Oviedo, Servicio de Salud del Principado de Asturias, Instituto de Neurociencias del Principado de Asturias (INEUROPA), CIBERSAM, Oviedo, Asturias, Spain
| | - Roberto Rodríguez-Jiménez
- Departamento de Psiquiatría, Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), CogPsy-Group, Universidad Complutense de Madrid (UCM), CIBERSAM, Madrid, Spain
| | - Salvador Sarró
- FIDMAG Research Foundation Germanes Hospitalàries, CIBERSAM, Barcelona, Spain
| | - Fernando Contreras
- Psychiatry Department, Bellvitge University Hospital-IDIBELL, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Ángela Ibáñez
- Departamento de Psiquiatría, Hospital Ramon y Cajal, Universidad de Alcalá, IRYCIS, CIBERSAM, Madrid, Spain
| | - Miguel Gutiérrez
- Department of Psychiatry, Hospital Santiago Apóstol, University of the Basque Country, CIBERSAM, Vitoria, Spain
| | - Juan Antonio Micó
- Grupo de Investigación en Neuropsicofarmacología y Psicobiología, Departamento de Neurociencias, Universidad de Cádiz, Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Hospital Universitario Puerta del Mar, CIBERSAM, Cádiz, Spain
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Scheffler F, Phahladira L, Luckhoff H, du Plessis S, Asmal L, Kilian S, Forti MD, Murray R, Emsley R. Cannabis use and clinical outcome in people with first-episode schizophrenia spectrum disorders over 24 months of treatment. Psychiatry Res 2021; 302:114022. [PMID: 34052461 DOI: 10.1016/j.psychres.2021.114022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/15/2021] [Indexed: 11/18/2022]
Abstract
Cannabis use is associated with an unfavourable course of illness in schizophrenia, although several factors may confound this association. In this longitudinal study, we explored the influence of cannabis use on baseline symptom severity and treatment outcomes in 98 patients with first-episode schizophrenia spectrum disorders treated with a long acting injectable antipsychotic over 24 months. Using mixed models for repeated measures, we compared visit-wise changes in psychopathology, social and occupational functioning and quality of life between recent/current cannabis users (n=45) and non-users (n=53). There were no significant group by time interactions for any of our outcomes, and with the exception of poorer functionality in cannabis users at baseline, no significant differences in these domains at baseline or month 24. Also, remission rates were similar. However, more cannabis users met our operationally defined relapse criteria compared to non-users, and more frequent cannabis use over the course of treatment, as assessed by positive urine toxicology testing, predicted relapse. Our results suggest that cannabis users do not have poorer treatment response than non-users in terms of symptom reduction over the 24 months of treatment. However, dose-related risk of relapse remains with ongoing cannabis use, possibly by directly reducing the threshold for psychotic breakthrough.
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Affiliation(s)
- Freda Scheffler
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Lebogang Phahladira
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Hilmar Luckhoff
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Stefan du Plessis
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Laila Asmal
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sanja Kilian
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marta Di Forti
- Social Genetic & Developmental Psychiatry, King's College, London, UK
| | - Robin Murray
- Department of Psychosis Studies, King's College, London, UK
| | - Robin Emsley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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10
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Bhattacharyya S, Schoeler T, Patel R, di Forti M, Murray RM, McGuire P. Individualized prediction of 2-year risk of relapse as indexed by psychiatric hospitalization following psychosis onset: Model development in two first episode samples. Schizophr Res 2021; 228:483-492. [PMID: 33067054 DOI: 10.1016/j.schres.2020.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 06/17/2020] [Accepted: 09/23/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although most patients with psychotic disorders experience relapse, it is not possible to predict whether or when an individual patient is going to relapse. We aimed to develop a multifactorial risk prediction algorithm for predicting risk of relapse in first episode psychosis (FEP). METHODS Data from two prospectively collected cohorts of FEP patients (N = 1803) were used to develop three multiple logistic prediction models to predict risk of relapse (defined as hospitalization) within the first 2 years of onset of psychosis. Model 1 (M1S1) used data obtained from clinical notes (Sample 1) while model 2 (M2S2) applied the same set of predictors using data obtained from research interviews (Sample 2). The final model (Sample 2: M3S2) used the same predictors plus additional detailed information on predictors. Model performance was evaluated employing measures of overall accuracy, calibration, discrimination and internal validation. RESULTS In both samples, the 2-year probability of psychiatric hospitalization was 37%. Of all the models, discrimination accuracy was lowest when limited information (such as socio-demographic and clinical parameters) was included in the prediction model. Model M3S2 using additional information (descriptors of pattern of cannabis, nicotine, alcohol and other illicit drug use) obtained from research interview had the best discrimination accuracy (Harrell's C index 0.749). CONCLUSIONS The measures that contributed most to predicting hospitalization are readily accessible in routine clinical practice, suggesting that a risk prediction tool based on these models would be clinically practicable following validation in independent samples and permit a personalized approach to relapse prevention in psychosis.
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Affiliation(s)
- Sagnik Bhattacharyya
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; South London and Maudsley NHS Foundation Trust, Denmark Hill, Camberwell, London, UK.
| | - Tabea Schoeler
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Rashmi Patel
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; South London and Maudsley NHS Foundation Trust, Denmark Hill, Camberwell, London, UK
| | - Marta di Forti
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; South London and Maudsley NHS Foundation Trust, Denmark Hill, Camberwell, London, UK
| | - Robin M Murray
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; South London and Maudsley NHS Foundation Trust, Denmark Hill, Camberwell, London, UK
| | - Philip McGuire
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; South London and Maudsley NHS Foundation Trust, Denmark Hill, Camberwell, London, UK
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11
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Oh H, Jang SK, Lee HS, Lee EB, Choi KH. Personality Traits in Individuals with the Dual Diagnosis of Psychosis and Substance Use Disorders: A Comprehensive Review and Meta-Analysis. J Dual Diagn 2021; 17:34-51. [PMID: 33404373 DOI: 10.1080/15504263.2020.1839827] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Substance abuse comorbidity is highly prevalent and is linked to detrimental outcomes in individuals with psychotic disorder, but the role of personality traits as the underlying mechanism is being increasingly underscored. This study aimed to profile temperamental risks of comorbid substance use disorder in psychotic disorders by performing meta-analyses on personality trait differences between psychotic disorders with comorbidity (dual diagnosis; DD) and without it (psychotic disorders; PSD). Methods: A systematic review of English articles using PubMed, MEDLINE, Scopus, Google Scholar, and ProQuest Dissertation and Theses. Only original empirical studies including participants with diagnosis of psychotic disorders based on structured diagnostic interviews, with and without substance use disorder evaluated with reliable and valid tests were included. Articles were independently extracted by two authors using predefined data fields, including study quality indicators. All pooled analyses were based on random-effect models. Thirteen studies (N = 885) met our inclusion criteria. All effect-size estimates were calculated based on means and standard deviations of included measures. Separate effect size estimates were obtained for four traits in the UPPS model (negative urgency, low premeditation, low perseverance, sensation seeking), four traits in the HS model (unconscientious disinhibition, negative affect, disagreeable disinhibition, positive affect) and trait anhedonia. Results: Negative urgency (four studies with 262 participants; ES = 0.59; 95% confidence interval [CI] [0.34, 0.84]), low premeditation (five studies with 349 participants; ES = 0.60; 95% CI [0.39, 0.80]), sensation seeking (seven studies with 550 participants; ES = 0.63; 95% CI [0.17, 1.09]) and unconscientious disinhibition (five studies with 291 participants; ES = 0.36; 95% CI [0.13, 0.59]) were elevated in DD than PSD. Heterogeneity of sensation seeking was significant (I2 = 86.2%). Conclusions: The findings of the current meta-analysis highlight a unique profile of impulsive and externalizing trait personality domains pertaining to DD. The study emphasizes the importance of emotion regulation interventions targeting impulsivity or negative affect (i.e. negative urgency, low premeditation) in substance abuse comorbidity patients.
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Affiliation(s)
- Hyeonju Oh
- Department of Psychology, Korea University, Seongbuk-gu, Republic of Korea
| | - Seon-Kyeong Jang
- Department of Psychology, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Hyeon-Seung Lee
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Eun-Byeol Lee
- Department of Psychology, Korea University, Seongbuk-gu, Republic of Korea
| | - Kee-Hong Choi
- Department of Psychology, Korea University, Seongbuk-gu, Republic of Korea
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12
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Ouellet-Plamondon C, Abdel-Baki A, Jutras-Aswad D. Premier épisode psychotique et trouble de l’usage de substance concomitants : revue narrative des meilleures pratiques et pistes d’approches adaptées pour l’évaluation et le suivi. SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088186ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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13
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Bernardo M, Amoretti S, Cuesta MJ, Parellada M, Mezquida G, González-Pinto A, Bergé D, Lobo A, Aguilar EJ, Usall J, Corripio I, Bobes J, Rodríguez-Jiménez R, Sarró S, Contreras F, Ibáñez Á, Gutiérrez M, Micó JA. The prevention of relapses in first episodes of schizophrenia: The 2EPs Project, background, rationale and study design. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2020. [PMID: 33020032 DOI: 10.1016/j.rpsm.2020.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Up to 80% of first-episode psychosis patients suffer a relapse within five years of the remission. Relapse should be an important focus of prevention given the potential harm to the patient and family. It threatens to disrupt their psychosocial recovery, increases the risk of resistance to treatment and has been associated with greater direct and indirect costs for society. Based on a previous project entitled "Genotype-phenotype and environment. Application to a predictive model in first psychotic episodes" (PEPs Project), the project "Clinical and neurobiological determinants of second episodes of schizophrenia. Longitudinal study of first episode of psychosis" was designed, also known as the 2EPs Project. It aimed to identify and characterize those factors that predict a relapse within the years immediately following a first episode. This project has focused on following the clinical course, with neuropsychological assessments, biological and neuroanatomical measures, genetic adherence and physical health monitoring in order to compare a subgroup of patients with a second episode to another group of patients which remains in remission. The main objective of the present article is to describe the rationale of the 2EPs Project, explaining the measurement approach adopted and providing an overview of the selected clinical and functional measures. 2EPs Project is a multicenter, coordinated, naturalistic, longitudinal follow-up study over three years in a Spanish sample of patients in remission after a first-psychotic episode of schizophrenia. It is closely monitoring the clinical course of the cases recruited to compare the subgroup of patients with a second episode to that which remains in remission. The sample is composed of 223 subjects recruited from 15 clinical centres in Spain with experience of the preceding PEPs Study project, albeit 2EPs being an expanded version with new basic groups in biological research. From the total sample recruited, 63 patients presented a relapse (44%). 2EPs arose to characterize first episodes in an exhaustive, novel and multimodal way, thus contributing towards the development of a predictive model of relapse. Identifying the characteristics of patients who relapse could improve early detection and intervention.
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Affiliation(s)
- Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain; Departament de Medicina, Institut de Neurociències, Universitat de Barcelona, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
| | - Silvia Amoretti
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain; Departament de Medicina, Institut de Neurociències, Universitat de Barcelona, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Manuel Jesús Cuesta
- Departamento de Psiquiatría, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain
| | - Mara Parellada
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Servicio de Psiquiatría del Niño y del Adolescente, Hospital General Universitario Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, CIBERSAM, Madrid, España
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain; Departament de Medicina, Institut de Neurociències, Universitat de Barcelona, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | | | - Ana González-Pinto
- Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Department of Neurociences, University of the Basque Country, CIBERSAM, Vitoria, Spain
| | - Daniel Bergé
- Department of Neurosciences and Psychiatry, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Antonio Lobo
- Department of Medicine and Psychiatry. Universidad de Zaragoza. Instituto de Investigación Aragón, CIBERSAM, Zaragoza, Spain
| | - Eduardo J Aguilar
- Department of Psychiatry, Hospital Clínico Universitario de Valencia, School of Medicine, Universidad de Valencia, CIBERSAM, Valencia, Spain
| | - Judith Usall
- Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, SantBoi de Llobregat; Fundació Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Iluminada Corripio
- Department of Psychiatry, Biomedical Research Institute Sant Pau (IIB-SANT PAU), Santa Creu and Sant Pau Hospital; Autonomous University of Barcelona (UAB), CIBERSAM, Barcelona, Spain
| | - Julio Bobes
- Área de Psiquiatría, Universidad de Oviedo, Servicio de Salud del Principado de Asturias, Instituto de Neurociencias del Principado de Asturias (INEUROPA), CIBERSAM, Oviedo, Asturias, Spain
| | - Roberto Rodríguez-Jiménez
- Departamento de Psiquiatría, Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), CogPsy-Group, Universidad Complutense de Madrid (UCM), CIBERSAM, Madrid, Spain
| | - Salvador Sarró
- FIDMAG Research Foundation Germanes Hospitalàries, CIBERSAM, Barcelona, Spain
| | - Fernando Contreras
- Psychiatry Department, Bellvitge University Hospital-IDIBELL, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Ángela Ibáñez
- Departamento de Psiquiatría, Hospital Ramon y Cajal, Universidad de Alcalá, IRYCIS, CIBERSAM, Madrid, Spain
| | - Miguel Gutiérrez
- Department of Psychiatry, Hospital Santiago Apóstol, University of the Basque Country, CIBERSAM, Vitoria, Spain
| | - Juan Antonio Micó
- Grupo de Investigación en Neuropsicofarmacología y Psicobiología, Departamento de Neurociencias, Universidad de Cádiz, Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Hospital Universitario Puerta del Mar, CIBERSAM, Cádiz, Spain
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14
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Abdel-Baki A, Thibault D, Medrano S, Stip E, Ladouceur M, Tahir R, Potvin S. Long-acting antipsychotic medication as first-line treatment of first-episode psychosis with comorbid substance use disorder. Early Interv Psychiatry 2020; 14:69-79. [PMID: 31125513 DOI: 10.1111/eip.12826] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 01/11/2019] [Accepted: 04/14/2019] [Indexed: 12/13/2022]
Abstract
AIM Substance use disorder (SUD) is highly prevalent among patients with first-episode psychosis (FEP) and associated with poor adherence and worst treatment outcomes. Although relapses are frequent in FEP, current literature on long-acting injectable antipsychotics (LAI-AP) use in FEP is scarce and studies often exclude patients with SUD. OBJECTIVES To determine the impact of LAI-AP as first-line treatment on psychotic relapses or rehospitalizations in FEP patients with comorbid SUD (FEP-SUD). METHODS This is a naturalistic, longitudinal, 3-year prospective and retrospective study on 237 FEP-SUD admitted in two EIS in Montreal, between 2005 and 2012. The patients were divided on the basis of first-line medication introduced, either oral antipsychotics (OAP, n = 206) or LAI-AP (n = 31). Baseline characteristics were compared using χ² test and analysis of variance, and Kaplan-Meier survival analysis was performed on relapse and rehospitalization. RESULTS Compared to the OAP group, patients in the LAI-AP group presented worse prognostic factors (eg, history of homelessness). Despite this, the LAI-AP group presented a lower relapse rate (67.7% vs 76.7%), higher relapse-free survival time (694 vs 447 days, P = 0.008 in Kaplan-Meier analysis), and trends for reduced rehospitalization rates (48.4% vs 57.3%) and hospitalization-free survival time (813 vs 619 days, P = 0.065 Kaplan-Meier analysis). Of those receiving OAP as first-line, 41.3% were eventually switched to LAI-AP and displayed worst outcome in relapse and rehospitalization. CONCLUSION LAI-AP should be strongly considered as first-line treatment of FEP-SUD patients since this pharmacological option reduces the risk of relapse and rehospitalization even in the individuals with poor prognostic factors.
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Affiliation(s)
- Amal Abdel-Baki
- Department of Psychiatry, University of Montreal, Canada.,Department of Psychiatry, Centre hospitalier de l'Université de Montréal, Canada
| | | | - Sofia Medrano
- Department of Psychiatry, University of Montreal, Canada
| | - Emmanuel Stip
- Department of Psychiatry, University of Montreal, Canada.,Department of Psychiatry, Centre hospitalier de l'Université de Montréal, Canada
| | - Martin Ladouceur
- Centre de recherche duCentre hospitalier de l'Université de Montréal (CRCHUM), Canada
| | - Ramzan Tahir
- Centre de recherche duCentre hospitalier de l'Université de Montréal (CRCHUM), Canada
| | - Stephane Potvin
- Department of Psychiatry, University of Montreal, Canada.,Centre de recherche de l'Institut Universitaire en Santé mentale de Montréal, Canada
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15
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Setién-Suero E, Neergaard K, Ortiz-García de la Foz V, Suárez-Pinilla P, Martínez-García O, Crespo-Facorro B, Ayesa-Arriola R. Stopping cannabis use benefits outcome in psychosis: findings from 10-year follow-up study in the PAFIP-cohort. Acta Psychiatr Scand 2019; 140:349-359. [PMID: 31381129 DOI: 10.1111/acps.13081] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the long-term (up to 10 years) patterns related to cannabis use in a sample of patients with first episode of psychosis (FEP) and the effect that consumption might have on clinical, functioning, and neurocognition at long-term. METHODS Cannabis use was described in 209 FEP patients. Patients were divided into three groups according to cannabis use: persistent users, ex-users, and never-users. Groups were longitudinally (baseline and 10-year follow-up) compared on clinical, functional, and cognitive variables. RESULTS Clinical differences at 10-year follow-up were observed between persistent cannabis users and the other two groups (ex-users and never-users), showing persistent users more severe symptoms (BPRS: x2 = 15.583, P ≤ 0.001; SAPS: x2 = 12.386, P = 0.002) and poorer functionality (DAS: x2 = 6.067, P = 0.048; GAF: x2 = 6.635, P = 0.033). Patients who stopped cannabis use prior to the reassessment showed a similar pattern to those who had never consumed. CONCLUSION The use of cannabis could negatively affect the evolution of the psychotic disorder. Perhaps the negative effects caused by cannabis use could be reversed with the cessation of consumption. It is necessary to make an effort in the intervention toward an early withdrawal from the use of cannabis, since this could play an important role in the prognosis of the disease.
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Affiliation(s)
- E Setién-Suero
- Department of Psychiatry, School of Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain.,IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.,CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain
| | - K Neergaard
- Department of Laboratoire Parole et Langage, Aix-Marseille Université, Marseille, France
| | - V Ortiz-García de la Foz
- IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.,CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain
| | - P Suárez-Pinilla
- Department of Psychiatry, School of Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain.,IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.,CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain
| | - O Martínez-García
- Department of Psychiatry, School of Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain
| | - B Crespo-Facorro
- CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain.,Hospital Universitario Virgen del Rocio, IBiS, Sevilla, Spain.,Departamento de Psiquiatría, Universidad de Sevilla, Sevilla, Spain
| | - R Ayesa-Arriola
- Department of Psychiatry, School of Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain.,IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.,CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain
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16
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Mustafa S, Bougie J, Miguelez M, Clerzius G, Rampakakis E, Proulx J, Malla A. Real-life assessment of aripiprazole monthly (Abilify Maintena) in schizophrenia: a Canadian naturalistic non-interventional prospective cohort study. BMC Psychiatry 2019; 19:114. [PMID: 30991969 PMCID: PMC6469112 DOI: 10.1186/s12888-019-2103-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/04/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND With previously established efficacy of aripiprazole once-monthly injectable formulation (AOM) in pre-registration randomized controlled trials, the current study was designed to evaluate its effectiveness in patients treated for schizophrenia in regular clinical settings in Canada. METHODS Following their clinicians' decision to prescribe AOM, 193 patients with a diagnosis of schizophrenia, were recruited from 17 Canadian community or hospital-based settings. The primary outcome of global functioning was assessed with the Global Assessment of Functioning Scale (GAF) at 3-month intervals for 1 year. Secondary outcomes (social and occupational functioning and illness severity) and adverse drug reactions (ADR) were also assessed. RESULTS A majority of the 169 evaluable patients were within the first 5 years of diagnosis (early phase). A linear mixed model analysis showed a significant main effect of time (Type III test p < 0.001) after adjusting for baseline GAF score, with a change in mean GAF scores from 49 at baseline to 61 at 12 months. No differences between early vs late phase were observed. Results on secondary outcome measures of function (Social and Occupational Functioning Scale) and illness severity (Clinical Global Impression-Severity Scale and Brief Psychiatric Rating Scale) were similar. Serious ADRs were observed in 29 (14.6%) patients and akathisia in 18 (9.1%) patients. At month-12, significant (≥7%) weight gain was observed in 25.7% (n = 27/105) of patients. CONCLUSIONS Treatment with AOM is effective in improving symptoms and functioning in schizophrenia patients treated in regular clinical settings. Akathisia was infrequent while one quarter of patients gained clinically significant weight. TRIAL REGISTRATION Unique identifier: NCT02131415 . First posted: 06 May 2014.
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Affiliation(s)
- Sally Mustafa
- Douglas Mental Health University Institute, Montreal, Quebec Canada
| | | | - Maia Miguelez
- Otsuka Canada Pharmaceutical Inc, Montreal, Quebec Canada
| | | | | | - Jean Proulx
- Lundbeck Canada Inc, Montreal, Quebec Canada
| | - Ashok Malla
- Douglas Mental Health University Institute, Montreal, Quebec Canada
- Department of Psychiatry, McGill University, Montreal, Quebec Canada
- ACCESS-Canada, 6625, boulevard LaSalle, Montreal, QC H4H 1R3 Canada
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17
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Lal S, Malla A, Marandola G, Thériault J, Tibbo P, Manchanda R, Williams R, Joober R, Banks N. "Worried about relapse": Family members' experiences and perspectives of relapse in first-episode psychosis. Early Interv Psychiatry 2019; 13:24-29. [PMID: 28524541 DOI: 10.1111/eip.12440] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 12/19/2016] [Accepted: 01/19/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The purpose of this study was to gain an in-depth understanding on the subject of relapse from the perspectives of family members of young people receiving services for a first-episode psychosis (FEP). METHODS A qualitative descriptive approach, using focus group methods, was used to elicit experiences, understandings, and knowledge of relapse in FEP. Family members were recruited from 4 specialized early intervention programmes for psychosis in Canada. A total of 24 (6 male, 18 female) family members participated in the study. Thematic analysis was used to examine the data. RESULTS The core underlying theme in all focus groups was worrying about relapse, which was often accompanied by significant levels of fear and anxiety, and was influenced by: (1) impact of an episode of psychosis; (2) limited confidence in recognizing and coping with relapse; (3) unmet needs for coping skills and emotional support and (4) unmet needs regarding frequency and continuity of communication with clinicians. CONCLUSIONS Family members' unmet needs for relapse-focused education, support and communication with service providers and peers, can have a negative impact on relapse prevention. Addressing family members' education and support needs in a tailored manner (including preferences for types of peer support) can contribute positively to their confidence and ability to recognize and respond to relapse. This can help reduce fear and anxieties about relapse, and positively influence the ability to function as caregivers. Future research should focus on best approaches for providing education, sustained contact with the clinical team and family peer support.
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Affiliation(s)
- Shalini Lal
- School of Rehabilitation, University of Montreal, Québec, Canada.,Health Innovation and Evaluation Hub, University of Montreal's Hospital Research Centre (CRCHUM), Montréal, Québec, Canada.,PEPP-Montreal & ACCESS Open Minds, Douglas Mental Health University Institute, Montréal, Québec, Canada
| | - Ashok Malla
- PEPP-Montreal & ACCESS Open Minds, Douglas Mental Health University Institute, Montréal, Québec, Canada.,Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Gina Marandola
- PEPP-Montreal & ACCESS Open Minds, Douglas Mental Health University Institute, Montréal, Québec, Canada
| | - Joanie Thériault
- School of Rehabilitation, University of Montreal, Québec, Canada
| | - Phil Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rahul Manchanda
- PEPP-London, London Health Sciences Centre, London, Ontario, Canada
| | - Richard Williams
- Victoria EPI Program, Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Ridha Joober
- PEPP-Montreal & ACCESS Open Minds, Douglas Mental Health University Institute, Montréal, Québec, Canada.,Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Nicola Banks
- Canadian Consortium for Early Intervention in Psychosis, Hamilton, Ontario, Canada
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18
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Böckmann V, Lay B, Seifritz E, Kawohl W, Roser P, Habermeyer B. Patient-Level Predictors of Psychiatric Readmission in Substance Use Disorders. Front Psychiatry 2019; 10:828. [PMID: 32038313 PMCID: PMC6988786 DOI: 10.3389/fpsyt.2019.00828] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/18/2019] [Indexed: 12/17/2022] Open
Abstract
Repeated psychiatric readmissions are a particular challenge in the treatment of substance use disorders and are associated with substantial burden for patients and their associates and for healthcare providers. Factors affecting readmission rates are heterogeneous and need to be identified to better allocate resources. Within the Swiss healthcare system, such data on substance use disorder patients are largely missing. Understanding these factors might bear important implications for future healthcare planning. Thus here, we examine risk factors of inpatient readmission. We retrospectively analyzed all admissions to the hospital's department of addictive disorders in the year 2016. Patients included in the study were followed over a period of 1 year after discharge regarding readmissions to the clinic. Besides the demographic, social, and economic data, we extracted data concerning patient history, admission, and discharge as well as clinical data regarding type and number of substances abused and comorbid diagnoses. In order to describe severity of cases, we furthermore included the scores of the Health of the Nation Outcome Scale (HoNOS) at admission and at discharge as documented in the medical database. Of the 554 patients included in the study, 228 (41.2%) were readmitted within 12 months. Previous admissions, concomitant use of different substances, presence of psychosis or mania, and a higher severity score at discharge increased the likelihood of readmission. The odds for readmission were furthermore higher in patients not being married, living alone, and being unemployed. When all (bivariate) statistically significant factors are included into a logistic regression model, the previous number of admissions and the HoNOS clinical score at discharge significantly contributed to this model. Our findings stress that patients with higher symptom load at discharge are prone to be readmitted within 12 months. The same applies for patients with previous admissions. These findings suggest that the development of specific interventions to prevent premature discharge before satisfactory symptom remission, in particular in those patients with previous admissions in their patient history, might help to prevent readmissions.
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Affiliation(s)
- Volker Böckmann
- Department of Addictive Disorders, Psychiatric Services Aargau, Brugg, Switzerland
| | - Barbara Lay
- Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Brugg, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Wolfram Kawohl
- Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Brugg, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Patrik Roser
- Department of Addictive Disorders, Psychiatric Services Aargau, Brugg, Switzerland
| | - Benedikt Habermeyer
- Department of Addictive Disorders, Psychiatric Services Aargau, Brugg, Switzerland
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19
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Patterns in adolescent cannabis use predict the onset and symptom structure of schizophrenia-spectrum disorder. Schizophr Res 2018; 197:539-543. [PMID: 29402581 DOI: 10.1016/j.schres.2018.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 01/13/2018] [Accepted: 01/14/2018] [Indexed: 12/29/2022]
Abstract
This study investigated adolescent cannabis use as a risk factor for schizophrenia spectrum disorder (SSD). Motives for early cannabis use and resulting usage patterns were examined alongside clinical measures of SSD onset and symptomatology. Participants (N = 178) were recruited for two samples, 1: healthy controls (HC) with cannabis use, 2: schizophrenia patients (SSD) with cannabis use. Structured interviews of participants and family informants were used to obtain diagnostic and biographical information. Factor-analysis of reported motives for initiating cannabis use produced four groups; sedation, stimulation, social pressure, and recreation. Regression analyses revealed significant relationships between these groups and SSD. Most notably, reason group factor scores predict SSD risk as well as schizotypal symptom severity. Findings also indicate that these factors follow a hierarchical structure, which explains their relative involvement in increased SSD risk. We suggest that adolescent cannabis use both hastens the onset and amplifies the severity of SSD. In response we propose a model for identifying at risk individuals, predicting the onset and severity of SSD, and potentially mitigating the associated psychiatric impairments.
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Rømer Thomsen K, Thylstrup B, Pedersen MM, Pedersen MU, Simonsen E, Hesse M. Drug-related predictors of readmission for schizophrenia among patients admitted to treatment for drug use disorders. Schizophr Res 2018; 195:495-500. [PMID: 28965780 DOI: 10.1016/j.schres.2017.09.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 09/21/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Patients with schizophrenia and comorbid drug use disorders (DUD) have a severe course of illness. Despite strong evidence that drug use can exacerbate psychotic symptoms, we have limited knowledge of how specific drugs may increase risk of schizophrenia readmission in this group. This study aimed to assess drug-related predictors of readmission for schizophrenia among a national cohort of patients with a history of schizophrenia admitted to DUD treatment. METHODS A record-linkage study was used to assess drug-related factors associated with readmission to mental health treatment for schizophrenia, using a consecutive cohort of 634 patients admitted to DUD treatment between 2000 and 2006 in Danish treatment services and tracked until February 2013 or death, controlling for baseline psychiatric treatment variables. RESULTS The majority of patients were males (79.8%) and the mean age was 34.7years. Of all patients, 78.7% were readmitted for schizophrenia during follow-up, and 6.8% died without having been readmitted. We found a robust association between use of amphetamine at baseline and elevated risk of readmission, a less robust association between use of cannabis and elevated risk of readmission, and no association with cocaine, opioids, alcohol, benzodiazepines, and MDMA. Furthermore, one or more psychiatric inpatients visit in the year prior to DUD admission was robustly associated with elevated risk of schizophrenia readmission. CONCLUSIONS Use of amphetamine and cannabis are risk markers for schizophrenia readmission among patients with a history of schizophrenia and DUD. Psychiatric history is a predictor of schizophrenia readmission in this patient group.
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Affiliation(s)
- Kristine Rømer Thomsen
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Allé 10, 8000 Aarhus C, Denmark.
| | - Birgitte Thylstrup
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Allé 10, 8000 Aarhus C, Denmark.
| | - Michael Mulbjerg Pedersen
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Allé 10, 8000 Aarhus C, Denmark.
| | - Mads Uffe Pedersen
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Allé 10, 8000 Aarhus C, Denmark.
| | - Erik Simonsen
- Psychiatric Research Unit, Psychiatry Region Zealand, Toftebakken 9, 4000 Roskilde, Denmark; Institute of Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.
| | - Morten Hesse
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Allé 10, 8000 Aarhus C, Denmark.
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21
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Ouellet-Plamondon C, Abdel-Baki A, Salvat É, Potvin S. Specific impact of stimulant, alcohol and cannabis use disorders on first-episode psychosis: 2-year functional and symptomatic outcomes. Psychol Med 2017; 47:2461-2471. [PMID: 28424105 DOI: 10.1017/s0033291717000976] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Many studies have concluded that cannabis use disorder (CUD) negatively influences outcomes in first-episode psychosis (FEP). However, few have taken into account the impact of concurrent misuse of other substances. METHODS This 2-year, prospective, longitudinal study of FEP patients, aged between 18 and 30 years, admitted to early intervention programs in Montreal, Quebec, Canada, examined the specific influence of different substance use disorders (SUD) (alcohol, cannabis, cocaine, amphetamines) on service utilization, symptomatic and functional outcomes in FEP. RESULTS Drugs and alcohol were associated with lower functioning, but drugs had a greater negative impact on most measures at 2-year follow-up. Half of CUD patients and more than 65% of cocaine or amphetamine abusers presented polysubstance use disorder (poly-SUD). The only group that deteriorated from years 1 to 2 (symptoms and functioning) were patients with persistent CUD alone. Outcome was worse in CUD than in the no-SUD group at 2 years. Cocaine, amphetamines and poly-SUD were associated with worse symptomatic and functional outcomes from the 1st year of treatment, persisting over time with higher service utilization (hospitalization). CONCLUSION The negative impact attributed to CUD in previous studies could be partly attributed to methodological flaws, like including polysubstance abusers among cannabis misusers. However, our investigation confirmed the negative effect of CUD on outcome. Attention should be paid to persistent cannabis misusers, since their condition seems to worsen over time, and to cocaine and amphetamine misusers, in view of their poorer outcome early during follow-up and high service utilization.
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Affiliation(s)
- C Ouellet-Plamondon
- Centre de recherche,Centre hospitalier de l'Université de Montréal (CRCHUM),Montreal, Quebec,Canada
| | - A Abdel-Baki
- Centre de recherche,Centre hospitalier de l'Université de Montréal (CRCHUM),Montreal, Quebec,Canada
| | - É Salvat
- Centre de recherche,Centre hospitalier de l'Université de Montréal (CRCHUM),Montreal, Quebec,Canada
| | - S Potvin
- Department of Psychiatry, Faculty of Medicine,Université de Montréal,Montreal, Quebec,Canada
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22
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Schoeler T, Petros N, Di Forti M, Klamerus E, Foglia E, Murray R, Bhattacharyya S. Poor medication adherence and risk of relapse associated with continued cannabis use in patients with first-episode psychosis: a prospective analysis. Lancet Psychiatry 2017; 4:627-633. [PMID: 28705600 PMCID: PMC5522816 DOI: 10.1016/s2215-0366(17)30233-x] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/03/2017] [Accepted: 05/05/2017] [Indexed: 12/04/2022]
Abstract
BACKGROUND Cannabis use following the onset of first-episode psychosis has been linked to both increased risk of relapse and non-adherence with antipsychotic medication. Whether poor outcome associated with cannabis use is mediated through an adverse effect of cannabis on medication adherence is unclear. METHODS In a prospective analysis of data acquired from four different adult inpatient and outpatient units of the South London and Maudsley Mental Health National Health Service Foundation Trust in London, UK, 245 patients were followed up for 2 years from the onset of first-episode psychosis. Cannabis use after onset of psychosis was assessed by self-reports in face-to-face follow-up interviews. Relapse data were collected from clinical notes using the WHO Life Chart Schedule. This measure was also used to assess medication adherence on the basis of both face-to-face interviews and clinical notes. Patients were included if they had a diagnosis of first-episode non-organic or affective psychosis according to ICD-10 criteria, and were aged between 18 and 65 years when referred to local psychiatric services. We used structural equation modelling analysis to estimate whether medication adherence partly mediated the effects of continued cannabis use on risk of relapse. The primary outcome variable was relapse, defined as admission to a psychiatric inpatient unit after exacerbation of symptoms within 2 years of first presentation to psychiatric services. Information on cannabis use over the first 2 years after onset of psychosis was investigated as a predictor variable for relapse. Medication adherence was assessed as a mediator variable on the basis of clinical records and self-report data. Study researchers (TS, NP, EK, and EF) rated the adherence. FINDINGS 397 patients who presented with their first episode of psychosis between April 12, 2002, and July 26, 2013 had a follow-up assessment until September, 2015. Of the 397 patients approached for followed up, 133 refused to take part in this study and 19 could not be included because of missing data. 91 (37%) of 245 patients with first-episode psychosis had a relapse over the 2 years of follow-up. Continued cannabis use predicted poor outcome, including risk of relapse, number of relapses, length of relapse, and care intensity at follow-up. In controlled structural equation modelling analyses, medication adherence partly mediated the effect of continued cannabis use on outcome, including risk of relapse (proportion mediated=26%, βindirect effects=0·08, 95% CI 0·004 to 0·16), number of relapses (36%, βindirect effects=0·07, 0·003 to 0·14), time until relapse (28%, βindirect effects=-0·26, -0·53 to 0·001) and care intensity (20%, βindirect effects=0·06, 0·004 to 0·11) but not length of relapse (6%, βindirect effects=0·03, -0·03 to 0·09). The adjusted models explained moderate amounts of variance for outcomes defined as risk of relapse (R2=0·25), number of relapses (R2=0·21), length of relapse (R2=0·07), time until relapse (R2=0·08), and care intensity index (R2=0·15). INTERPRETATION Between 20% and 36% of the adverse effects of continued cannabis use on outcome in psychosis might be mediated through the effects of cannabis use on medication adherence. Interventions directed at medication adherence could partly help mitigate the harm from cannabis use in psychosis. FUNDING This study is funded by the National Institute of Health Research (NIHR) Clinician Scientist award.
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Affiliation(s)
- Tabea Schoeler
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Natalia Petros
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Marta Di Forti
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ewa Klamerus
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Enrico Foglia
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Robin Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sagnik Bhattacharyya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
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23
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Weibell MA, Hegelstad WTV, Auestad B, Bramness J, Evensen J, Haahr U, Joa I, Johannessen JO, Larsen TK, Melle I, Opjordsmoen S, Rund BR, Simonsen E, Vaglum P, McGlashan T, McGorry P, Friis S. The Effect of Substance Use on 10-Year Outcome in First-Episode Psychosis. Schizophr Bull 2017; 43:843-851. [PMID: 28199703 PMCID: PMC5472130 DOI: 10.1093/schbul/sbw179] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Substance use is common in first-episode psychosis (FEP) and has been linked to poorer outcomes with more severe psychopathology and higher relapse rates. Early substance discontinuation appears to improve symptoms and function. However, studies vary widely in their methodology, and few have examined patients longitudinally, making it difficult to draw conclusions for practice and treatment. We aimed to investigate the relationship between substance use and early abstinence and the long-term course of illness in a representative sample of FEP patients. Out of 301 included patients, 266 could be divided into 4 groups based on substance use patterns during the first 2 years of treatment: persistent users, episodic users, stop-users and nonusers. Differences in clinical and functional measures during the follow-up period were assessed using linear mixed effects models for the analysis of repeated measures data. Patients who stopped using substances within the first 2 years after diagnosis had outcomes similar to those who had never used with fewer symptoms than episodic or persistent users. Both episodic and persistent users had lower rates of symptom remission than nonusers, and persistent users also had more negative symptoms than those who stopped using. Our findings emerge from one of very few long-term longitudinal studies examining substance use cessation in FEP with 10-year follow-up. The results convey hope that the detrimental effects of substance abuse on mental health may be significantly reversed if one stops the abuse in time. This can help patients who struggle with addiction with their motivation to embrace abstinence.
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Affiliation(s)
- Melissa A. Weibell
- Regional Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway;,Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Wenche ten Velden Hegelstad
- Regional Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | - Bjørn Auestad
- Department of Mathematics and Natural Sciences, University of Stavanger, Stavanger, Norway;,Research Department, Stavanger University Hospital, Stavanger, Norway
| | - Jørgen Bramness
- SERAF, Norwegian Centre for Addiction Research, Oslo, Norway;,Institute of Psychiatry, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Julie Evensen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ulrik Haahr
- Psychiatric Research Unit, Zealand Region, Psychiatry East and Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Roskilde, Denmark
| | - Inge Joa
- Regional Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway;,Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Jan Olav Johannessen
- Regional Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway;,Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Tor Ketil Larsen
- Regional Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway;,Institute of Psychiatry, University of Bergen, Bergen, Norway
| | - Ingrid Melle
- Institute of Psychiatry, Faculty of Medicine, University of Oslo, Oslo, Norway;,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Stein Opjordsmoen
- Institute of Psychiatry, Faculty of Medicine, University of Oslo, Oslo, Norway;,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, Oslo, Norway;,Vestre Viken Hospital Trust, Drammen, Norway
| | - Erik Simonsen
- Psychiatric Research Unit, Zealand Region, Psychiatry East and Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Roskilde, Denmark;,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
| | - Per Vaglum
- Institute of Psychiatry, Faculty of Medicine, University of Oslo, Oslo, Norway;,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia;,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Svein Friis
- Institute of Psychiatry, Faculty of Medicine, University of Oslo, Oslo, Norway;,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Rates and predictors of relapse in first-episode non-affective psychosis: a 3-year longitudinal study in a specialized intervention program (PAFIP). Eur Arch Psychiatry Clin Neurosci 2017; 267:315-323. [PMID: 27796500 DOI: 10.1007/s00406-016-0740-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 10/13/2016] [Indexed: 10/20/2022]
Abstract
Relapses may represent a critical hazard in schizophrenia spectrum disorders as they are associated with an increased risk of a clinical and functional deterioration. Preventing relapse after recovering from a first psychotic episode has become a major challenge due to its critical impact on lifelong functionality. This study explored the rate of first and second relapses and the predictors associated with these relapses in a large cohort of non-affective psychosis patients during a period of 3 years after the first break of the illness. From February 2001 to May 2014, sociodemographic and clinical data from an epidemiological cohort of 341 non-affective first-episode psychosis patients at risk of relapse were analysed at a specialized early intervention service. Logistic regression, Cox regression, and Kaplan-Meier survival analyses were performed to compare non-relapsed and relapsed patients. One hundred and sixty-six (48.7%) individuals relapsed at least once. Median time to relapse was 17.0 months in non-adherent patients and 40.0 months in adherent patients (log-rankχ 2: 51.36; p < 0.001). Non-adherence to medication (odds ratio-OR 2.979; p < 0.001), schizophrenia diagnosis (OR 2.173; p = 0.002), and age of onset (OR 1.020; p = 0.033) were the main predictors of the first relapse. Fifty-six subjects experienced a second relapse (33.73%) predicted by diagnosis (OR 1.975; p = 0.074), age of onset (OR 1.078; p = 0.003), and positive symptoms (OR 0.863; p = 0.03), but not adherence. Non-adherence is the main predictive factor of first relapse after a first episode of psychosis. Second relapses were not often and not related to modifiable factors, suggesting that multiple relapsed patients may comprise a subgroup with a higher biological risk.
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25
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Symptomatic and functional outcomes of substance use disorder persistence 2 years after admission to a first-episode psychosis program. Psychiatry Res 2017; 247:113-119. [PMID: 27888680 DOI: 10.1016/j.psychres.2016.11.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 09/12/2016] [Accepted: 11/05/2016] [Indexed: 11/23/2022]
Abstract
Substance use disorders (SUD) in first-episode psychosis (FEP) are highly prevalent and linked with poor outcomes. However, most longitudinal studies investigating their impacts in FEP have not reported proportions of patients who ceased SUD. Our aim was to examine the influence of SUD course on functional and symptomatic outcomes as well as service use in FEP. We performed a 2-year longitudinal study of 212 FEP patients, aged between 18 and 30 years, admitted to 2 early psychosis services in Montréal, Québec, Canada. We observed that cannabis was the first substance abused (42.9% at baseline), followed by alcohol (19.3%). The SUD rate decreased by approximately 30% during the first year. Patients with persistent SUD had worse functional outcomes (Quality of Life Scale, Social and Occupational Functioning Assessment Scale, employment), more symptoms (Positive and Negative Symptoms Scale) and heavier service use (emergency and hospitalization). SUD persistence was associated with illness severity, homelessness and cluster-B personality. Those living with their parents and financially supported by them were more likely to cease SUD. Our results indicate that SUD course was more significant than having SUD at admission; persistent SUD was associated with worse outcomes. SUD decreased during a general early psychosis intervention program (with no specialized SUD treatment). An integrated, specialized approach targeting FEP patients with predictive factors of SUD persistence during the first years of treatment might increase SUD cessation and possibly improve outcomes.
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26
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Malla A, Ota A, Nagamizu K, Perry P, Weiller E, Baker RA. The effect of brexpiprazole in adult outpatients with early-episode schizophrenia: an exploratory study. Int Clin Psychopharmacol 2016; 31:307-14. [PMID: 27571460 PMCID: PMC5049948 DOI: 10.1097/yic.0000000000000140] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The aim of this study was to evaluate flexibly dosed brexpiprazole for early-episode schizophrenia through the assessment of efficacy, social functioning, and tolerability. This was an exploratory, 16-week, open-label, flexible-dose (1, 2, 3, or 4 mg/day; target dose 3 mg/day) study in outpatients with early-episode schizophrenia (18-35 years old, ≤5 years' duration of illness). Efficacy was assessed by the Positive and Negative Syndrome Scale score (PANSS) and social functioning was assessed by changes from baseline in PANSS modified prosocial subscale, personal and social performance (PSP), and specific levels of functioning (SLOF) scales. Safety and tolerability were also evaluated. Overall, 25/49 patients completed the study. Symptoms of schizophrenia improved over the entire treatment period, as evidenced by reductions in PANSS total score from baseline (least squares mean change at week 16: -10.2). Improvements in social functioning were shown by least squares mean changes from baseline at week 16 in the PANSS prosocial subscale (-2.0), PSP (6.6), and SLOF (13.1). Brexpiprazole was generally well tolerated; the most common adverse events were insomnia (7/49 patients), somnolence (4/49), sedation, weight increase, and nausea (each 3/49). Brexpiprazole may represent a novel and effective treatment strategy for patients with early-episode schizophrenia and may be effective for improving social function.
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Affiliation(s)
- Ashok Malla
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ai Ota
- Otsuka Pharmaceutical Co., Tokyo, Japan
| | | | - Pamela Perry
- Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, New Jersey, USA
| | | | - Ross A. Baker
- Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, New Jersey, USA
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27
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Therapeutic effectiveness and tolerability of aripiprazole as initial choice of treatment in first episode psychosis in an early intervention service: A one-year outcome study. Schizophr Res 2016; 174:120-125. [PMID: 27157800 DOI: 10.1016/j.schres.2016.04.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 04/20/2016] [Accepted: 04/23/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Aripiprazole has been associated with a low prevalence of metabolic side effects as compared to other second generation antipsychotic (SGA) medications mostly in patients with long standing illness. The purpose of the present study was to assess specifically the effectiveness and safety of aripiprazole as a first choice for antipsychotic therapy for young patients presenting with a previously untreated first episode of a psychotic disorder (FEP). METHODS Seventy-three patients presenting with a FEP and with minimal prior exposure to antipsychotic medications were recruited to be part of an open label naturalistic outcome study using aripiprazole as the first choice of antipsychotic medication. Data on positive, negative and total symptom severity including general psychopathological symptoms, level of functioning and metabolic indices were collected prospectively over a one-year period. RESULTS As compared to baseline, patients treated with aripiprazole (mean dose 9.6mg) improved significantly on measures of positive (p<0.001), negative (p<0.001) and total severity-general psychopathology symptoms (p<0.001) and level of functioning (p<0.001). Seventy two percent of the participants achieved positive symptom remission and 50% achieved total remission (positive and negative) at one year of follow up. Unlike reports on patients with longer standing illness, significant weight gain (p<0.001) was observed, with 44% of participants experiencing >7% increase in body weight. CONCLUSION FEP patients starting treatment with aripiprazole improved on symptoms and social and occupational functioning. Aripiprazole was well tolerated except for a significant weight gain.
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28
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Dazzan P. Neuroimaging biomarkers to predict treatment response in schizophrenia: the end of 30 years of solitude? DIALOGUES IN CLINICAL NEUROSCIENCE 2015. [PMID: 25733954 PMCID: PMC4336919 DOI: 10.31887/dcns.2014.16.4/pdazzan] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Studies that have used structural magnetic resonance imaging (MRI) suggest that individuals with psychoses have brain alterations, particularly in frontal and temporal cortices, and in the white matter tracts that connect them. Furthermore, these studies suggest that brain alterations may be particularly prominent, already at illness onset, in those individuals more likely to have poorer outcomes (eg, higher number of hospital admissions, and poorer symptom remission, level of functioning, and response to the first treatment with antipsychotic drugs). The fact that, even when present, these brain alterations are subtle and distributed in nature, has limited, until now, the utility of MRI in the clinical management of these disorders. More recently, MRI approaches, such as machine learning, have suggested that these neuroanatomical biomarkers can be used for direct clinical benefits. For example, using support vector machine, MRI data obtained at illness onset have been used to predict, with significant accuracy, whether a specific individual is likely to experience a remission of symptoms later on in the course of the illness. Taken together, this evidence suggests that validated, strong neuroanatomical markers could be used not only to inform tailored intervention strategies in a single individual, but also to allow patient stratification in clinical trials for new treatments.
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Affiliation(s)
- Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK; National Institute for Health Research, Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
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29
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Kam SM, Singh SP, Upthegrove R. What needs to follow early intervention? Predictors of relapse and functional recovery following first-episode psychosis. Early Interv Psychiatry 2015; 9:279-83. [PMID: 24251970 DOI: 10.1111/eip.12099] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 09/22/2013] [Indexed: 11/27/2022]
Abstract
AIM As a foundation for considering how gains may be maintained following early intervention in first-episode psychosis (FEP), this study aimed to describe and investigate factors predicting post-discharge relapse and longer term functioning. METHOD An evaluation via case-note review obtained quantitative data on 163 patients sequentially discharged from Birmingham Early Intervention Service (EIS) followed up for a median of 3.6 years. Time to relapse was calculated and hierarchical regression was used to determine predictors of relapse and functioning. RESULTS Patients likely to relapse do so within the first year post-discharge; however, over 40% did not relapse during the follow-up period. The number of relapses occurring during EIS care predicted time-to-relapse post-discharge. At discharge from the EIS and study end-point, the proportion with low social and vocational functioning remained high. Predictors of positive 'Not in Education Employment or Training' status at end-point include being in a minority ethnic group, substance misuse and number of relapses. CONCLUSIONS Increased emphasis on relapse prevention and early post-discharge monitoring may be needed, especially in the first year, for those who have experienced previous relapse. To maintain early outcomes in FEP, targeted interventions to address substance misuse and functional recovery need to be sustained in the long term. EISs should aim to make the first episode of psychosis the last. Services providing care for patients with psychosis post EIS should be designed to deliver care for ongoing need, with continued emphasis on relapse prevention and social recovery.
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Affiliation(s)
- Shi Mei Kam
- College of Medical and Dental Sciences, The University of Birmingham
| | - Swaran P Singh
- Birmingham Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham.,Mental Health and Well Being, Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachel Upthegrove
- College of Medical and Dental Sciences, The University of Birmingham.,Birmingham Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham
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30
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Hui CLM, Chiu CPY, Li YK, Law CW, Chang WC, Chan SKW, Lee EHM, Sham P, Chen EYH. The Effect of Paternal Age on Relapse in First-Episode Schizophrenia. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:346-53. [PMID: 26454556 PMCID: PMC4542514 DOI: 10.1177/070674371506000803] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 11/01/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Multiple etiological and prognostic factors have been implied in schizophrenia and its outcome. Advanced paternal age has been reported as a risk factor in schizophrenia. Whether this may affect schizophrenia outcome was not previously studied. We hypothesized that advanced paternal age may have a negative effect on the outcome of relapse in schizophrenia. METHOD We interviewed 191 patients with first-episode schizophrenia and their relatives for parental ages, sociodemographic factors at birth, birth rank, family history of psychotic disorders, and obstetric complications. The outcome measure was the presence of relapse at the end of the first year of treatment. RESULTS In the 1-year follow-up period, 42 (22%) patients experienced 1 or more relapses. The mean paternal age was 34.62 years (SD 7.69). Patients who relapsed had significantly higher paternal age, poorer medication adherence, were female, and were hospitalized at onset, compared with patients who did not relapse. A multivariate regression analysis showed that advanced paternal age (OR 1.05, 95% CI 1.01 to 1.10), medication nonadherence (OR 2.37, 95% CI 1.12 to 4.99), and female sex (OR 2.44, 95% CI 1.14 to 5.24) independently contributed to a higher risk of relapse. Analysis between different paternal age groups found a significantly higher relapse rate with paternal age over 40. CONCLUSIONS Advanced paternal age is found to be modestly but significantly related to more relapses, and such an effect is the strongest at a cut-off of paternal age of 40 years or older. The effect is less likely to be mediated through less effective parental supervision or nonadherence to medication. Other possible biological mechanisms need further explorations.
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Affiliation(s)
- Christy L M Hui
- Research Assistant Professor, Department of Psychiatry, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Cindy P Y Chiu
- Clinical Assistant Professor, Department of Psychiatry, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yuet-Keung Li
- Research Assistant, Department of Psychiatry, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Chi-Wing Law
- Associate Consultant, Department of Psychiatry, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Wing-Chung Chang
- Clinical Assistant Professor, Department of Psychiatry, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Sherry K W Chan
- Clinical Assistant Professor, Department of Psychiatry, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Edwin H M Lee
- Clinical Assistant Professor, Department of Psychiatry, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Pak Sham
- Professor, Department of Psychiatry, University of Hong Kong, Hong Kong Special Administrative Region, China; Professor, State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Eric Y H Chen
- Professor, Department of Psychiatry, University of Hong Kong, Hong Kong Special Administrative Region, China; Professor, State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong Special Administrative Region, China
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Lutgens D, Iyer S, Joober R, Brown TG, Norman R, Latimer E, Schmitz N, Abdel Baki A, Abadi S, Malla A. A five-year randomized parallel and blinded clinical trial of an extended specialized early intervention vs. regular care in the early phase of psychotic disorders: study protocol. BMC Psychiatry 2015; 15:22. [PMID: 25881022 PMCID: PMC4336502 DOI: 10.1186/s12888-015-0404-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 02/02/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Specialized Early Intervention services (SEI) for first episode psychosis are shown to be effective for the treatment of positive and negative symptoms, medication adherence, rates of relapse, substance abuse disorders, functional outcome and quality of life at two-year treatment follow up. However, it is also reported that these benefits are not maintained when SEI is not sustained. The objective of this trial is to test the efficacy of a 3-year extension of a SEI service (following 2 years of SEI prior to randomization) for the maintenance and consolidation of therapeutic gains as compared to regular care in the community. METHODS Following an initial 2 years of SEI, patients are randomized to receive either 3-years of continued SEI or regular care. SEI provided at three sites within the McGill network of SEI services, using a model of treatment comprised of: modified assertive case management; psycho education for families; multiple family intervention; cognitive behavioural therapy; and substance abuse treatment and monitoring. Blinded research assistants conduct ongoing evaluation of the outcome variables every three months. The primary outcome measure is remission status measured both as the proportion of patients in complete remission and the mean length of remission achieved following randomization during the additional three years of follow up. Based on preliminary data, it is determined that a total of 212 patients are needed to achieve adequate statistical power. Intent to treat with the last observation carried forward will be the primary method of statistical analysis. DISCUSSION The "critical period" hypothesis posits that there is a five year window during which the effects of the nascent psychotic illness can be countered and the impact of the disorder on symptomatic and functional outcomes can be offset through active and sustained treatment. Providing SEI throughout this critical period may solidify the benefits of treatment such that gains may be more sustainable over time as compared to intervention delivered for a shorter period. Findings from this study will have implications for service provision in first episode psychosis. TRIAL REGISTRATION ISRCTN11889976.
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Affiliation(s)
- Danyael Lutgens
- Department of Psychiatry, McGill University; Prevention and Early Intervention Program for the Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada.
| | - Srividya Iyer
- Department of Psychiatry, McGill University; Program Coordinator, Prevention and Early Intervention Program for the Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada.
| | - Ridha Joober
- Department of Psychiatry, McGill University; Assistant Director, Prevention and Early Intervention Program for the Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada.
| | - Thomas G Brown
- Department of Psychiatry, McGill University; Douglas Hospital Research Centre, Montreal, Quebec, Canada.
| | - Ross Norman
- Department of Epidemiology and Biostatistics, Western University; Prevention and Early Intervention Program for Psychoses (PEPP), London Health Sciences Centre, South Street Hospital, London, Ontario, Canada.
| | - Eric Latimer
- Social and Transcultural Division, Department of Psychiatry, McGill, University; Douglas Hospital Research Centre, Montreal, Quebec, Canada.
| | - Norbert Schmitz
- Department of Psychiatry & Department of Epidemiology and Biostatistics, McGill, University; Douglas Hospital Research Centre, Montreal, Quebec, Canada.
| | - Amal Abdel Baki
- Department of Psychiatry, Université de Montréal, Research Centre CHUM, Montréal, QC, Canada.
| | - Sherezad Abadi
- Coordinator, Prevention and Early Intervention Program for the Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada.
| | - Ashok Malla
- Department of Psychiatry, McGill University; Director, Prevention and Early Intervention Program for the Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada.
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Tibbo P, Malla A, Manchanda R, Williams R, Joober R. Relapse risk assessment in early phase psychosis: the search for a reliable and valid tool. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:655-8. [PMID: 25702366 PMCID: PMC4304585 DOI: 10.1177/070674371405901207] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Phil Tibbo
- Professor and Dr Paul Janssen Chair in Psychotic Disorders, Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia; Director, Nova Scotia Early Psychosis Program, Halifax, Nova Scotia
| | - Ashok Malla
- Professor and Canada Research Chair in Early Psychosis, Department of Psychiatry, McGill University, Montreal, Quebec; Director, Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec
| | - Rahul Manchanda
- Professor, Department of Psychiatry, The University of Western Ontario, London, Ontario; Director, Prevention and Early Intervention Program for Psychoses, London Health Sciences Centre, London, Ontario
| | - Richard Williams
- Director of Schizophrenia Service, Vancouver Island Health Authority, Victoria, British Columbia; Adjunct Professor, Department of Psychology, University of Victoria, Victoria, British Columbia; Clinical Professor, Department of Psychiatry, University of British Columbia, Victoria, British Columbia
| | - Ridha Joober
- Professor, Department of Psychiatry, McGill University, Montreal, Quebec; Associate Director, Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec
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Morgan C, Lappin J, Heslin M, Donoghue K, Lomas B, Reininghaus U, Onyejiaka A, Croudace T, Jones PB, Murray RM, Fearon P, Doody GA, Dazzan P. Reappraising the long-term course and outcome of psychotic disorders: the AESOP-10 study. Psychol Med 2014; 44:2713-2726. [PMID: 25066181 PMCID: PMC4134320 DOI: 10.1017/s0033291714000282] [Citation(s) in RCA: 160] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Studies of the long-term course and outcome of psychoses tend to focus on cohorts of prevalent cases. Such studies bias samples towards those with poor outcomes, which may distort our understanding of prognosis. Long-term follow-up studies of epidemiologically robust first-episode samples are rare. METHOD AESOP-10 is a 10-year follow-up study of 557 individuals with a first episode of psychosis initially identified in two areas in the UK (South East London and Nottingham). Detailed information was collated on course and outcome in three domains (clinical, social and service use) from case records, informants and follow-up interviews. RESULTS At follow-up, of 532 incident cases identified, at baseline 37 (7%) had died, 29 (6%) had emigrated and eight (2%) were excluded. Of the remaining 458, 412 (90%) were traced and some information on follow-up was collated for 387 (85%). Most cases (265, 77%) experienced at least one period of sustained remission; at follow-up, 141 (46%) had been symptom free for at least 2 years. A majority (208, 72%) of cases had been employed for less than 25% of the follow-up period. The median number of hospital admissions, including at first presentation, was 2 [interquartile range (IQR) 1-4]; a majority (299, 88%) were admitted a least once and a minority (21, 6%) had 10 or more admissions. Overall, outcomes were worse for those with a non-affective diagnosis, for men and for those from South East London. CONCLUSIONS Sustained periods of symptom remission are usual following first presentation to mental health services for psychosis, including for those with a non-affective disorder; almost half recover.
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Affiliation(s)
- Craig Morgan
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London
| | - Julia Lappin
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London
- Psychosis Studies Department, Institute of Psychiatry, King’s College, London, UK
| | - Margaret Heslin
- Centre for Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK
| | - Kim Donoghue
- Addictions Department, Institute of Psychiatry, King’s College, London, UK
| | - Ben Lomas
- Division of Psychiatry, University of Nottingham, Nottingham, UK
| | - Ulrich Reininghaus
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK
| | - Adanna Onyejiaka
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK
| | - Tim Croudace
- Department of Health Sciences, University of York, York, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Robin M Murray
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London
- Psychosis Studies Department, Institute of Psychiatry, King’s College, London, UK
| | - Paul Fearon
- Department of Psychiatry, Trinity College, Dublin, Ireland
| | - Gillian A Doody
- Division of Psychiatry, University of Nottingham, Nottingham, UK
| | - Paola Dazzan
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London
- Psychosis Studies Department, Institute of Psychiatry, King’s College, London, UK
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Sapra M, Weiden PJ, Schooler NR, Sunakawa-McMillan A, Uzenoff S, Burkholder P. Reasons for adherence and nonadherence: a pilot study comparing first- and multi-episode schizophrenia patients. ACTA ACUST UNITED AC 2014; 7:199-206. [PMID: 23428784 DOI: 10.3371/csrp.sawe.020813] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
RATIONALE Most first-episode schizophrenia patients will stop their medication after their acute symptoms improve. Understanding the salient motivations and attitudes that drive adherence--as well as nonadherence--is an important part of developing strategies to prevent or delay nonadherence during the early phases of the illness. METHODS Self-reported reasons for adherence and nonadherence among first-episode and multi-episode patients with schizophrenia were obtained from cross-sectional adherence interviews from two prospective adherence studies: one composed of a first-episode sample (n=33) and the other with recently relapsing multi-episode patients (n=16). Both groups received the Rating of Medication Influences (ROMI) Scale at approximately 16 to 20 weeks after an acute psychotic episode. The specific ROMI items were ranked in order of percentage (%) strong, and were compared both within each patient group for rank order of importance, and also compared between groups to determine the differences in specific adherence and nonadherence influences. RESULTS The doctor-patient relationship was more likely to be endorsed as a strong adherence influence in the first-episode sample (74%) than in the multi-episode sample (13%, X²=18.07, p<.01). Change in physical appearance attributed to medication was a more commonly endorsed nonadherence influence for the multi-episode sample (25%) relative to the first-episode sample (0%, X²=9.2, p<.01). CONCLUSIONS The doctor-patient relationship stands out as being the major reason for ongoing adherence for first-episode schizophrenia patients. Our post hoc interpretation is that lack of prior experience with medication and treatment elevates the importance of the relationship with the treating clinician for first-episode patients.
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Affiliation(s)
- Mamta Sapra
- Department of Psychiatry, Salem VA Medical Center, 1970 Roanoke Blvd., Salem, VA 24153
| | - Peter J Weiden
- Center for Cognitive Medicine, University of Illinois, Chicago
| | - Nina R Schooler
- Department of Psychiatry & Behavioral Sciences, SUNY Downstate Medical Center
| | | | - Sarah Uzenoff
- Department of Psychology, University of North Carolina, Chapel Hill
| | - Page Burkholder
- Department of Behavioral Health,, Kings County Hospital Center
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Abstract
AbstractThis paper examines the concept of early intervention in psychosis at primary and secondary prevention levels. Examples of early intervention service models from different countries are presented and we discuss current evidence for efficacy. We highlight the Irish experience of early intervention to date, and discuss future implementation of early intervention services in Ireland.
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Sara GE, Burgess PM, Malhi GS, Whiteford HA, Hall WC. Cannabis and stimulant disorders and readmission 2 years after first-episode psychosis. Br J Psychiatry 2014; 204:448-53. [PMID: 24578446 DOI: 10.1192/bjp.bp.113.135145] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Few studies have examined the impact of stimulant use on outcome in early psychosis. Ceasing substance use may lead to positive outcomes in psychosis. AIMS To examine whether baseline cannabis or stimulant disorders and ongoing drug use predict readmission within 2 years of a first psychosis admission. METHOD Predictors of readmission were examined with Cox regression in 7269 people aged 15-29 years with a first psychosis admission. RESULTS Baseline cannabis and stimulant disorders did not predict readmission. A stimulant disorder diagnosis prior to index psychosis admission predicted readmission, but a prior cannabis disorder diagnosis did not. Ongoing problem drug use predicted readmission. The lowest rate of readmission occurred in people whose baseline drug problems were discontinued. CONCLUSIONS Prior admissions with stimulant disorder may be a negative prognostic sign in first-episode psychosis. Drug use diagnoses at baseline may be a good prognostic sign if they are identified and controlled.
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Affiliation(s)
- Grant E Sara
- Grant E. Sara, MB BS, MM, MM (Psychotherapy), FRANZCP, InforMH, Mental Health and Drug and Alcohol Office, NSW Health, Discipline of Psychiatry, Sydney Medical School, University of Sydney, and School of Population Health, University of Queensland, Brisbane, Queensland; Philip M. Burgess, MA, PhD, School of Population Health, Queensland Centre for Mental Health Research, University of Queensland, Brisbane, Queensland; Gin S. Malhi, MBChB, BSc, MD, FRCPsych, FRANZCP, Discipline of Psychiatry, Sydney Medical School, University of Sydney, Royal North Shore Hospital, and CADE Clinic, Department of Academic Psychiatry, Royal North Shore Hospital, Sydney, New South Wales; Harvey A. Whiteford, MB BS, MPH, MD, FRANZCP, Queensland Centre for Mental Health Research, University of Queensland, Brisbane, Queensland; Wayne C. Hall, MSc, PhD, Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
| | - Philip M Burgess
- Grant E. Sara, MB BS, MM, MM (Psychotherapy), FRANZCP, InforMH, Mental Health and Drug and Alcohol Office, NSW Health, Discipline of Psychiatry, Sydney Medical School, University of Sydney, and School of Population Health, University of Queensland, Brisbane, Queensland; Philip M. Burgess, MA, PhD, School of Population Health, Queensland Centre for Mental Health Research, University of Queensland, Brisbane, Queensland; Gin S. Malhi, MBChB, BSc, MD, FRCPsych, FRANZCP, Discipline of Psychiatry, Sydney Medical School, University of Sydney, Royal North Shore Hospital, and CADE Clinic, Department of Academic Psychiatry, Royal North Shore Hospital, Sydney, New South Wales; Harvey A. Whiteford, MB BS, MPH, MD, FRANZCP, Queensland Centre for Mental Health Research, University of Queensland, Brisbane, Queensland; Wayne C. Hall, MSc, PhD, Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
| | - Gin S Malhi
- Grant E. Sara, MB BS, MM, MM (Psychotherapy), FRANZCP, InforMH, Mental Health and Drug and Alcohol Office, NSW Health, Discipline of Psychiatry, Sydney Medical School, University of Sydney, and School of Population Health, University of Queensland, Brisbane, Queensland; Philip M. Burgess, MA, PhD, School of Population Health, Queensland Centre for Mental Health Research, University of Queensland, Brisbane, Queensland; Gin S. Malhi, MBChB, BSc, MD, FRCPsych, FRANZCP, Discipline of Psychiatry, Sydney Medical School, University of Sydney, Royal North Shore Hospital, and CADE Clinic, Department of Academic Psychiatry, Royal North Shore Hospital, Sydney, New South Wales; Harvey A. Whiteford, MB BS, MPH, MD, FRANZCP, Queensland Centre for Mental Health Research, University of Queensland, Brisbane, Queensland; Wayne C. Hall, MSc, PhD, Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
| | - Harvey A Whiteford
- Grant E. Sara, MB BS, MM, MM (Psychotherapy), FRANZCP, InforMH, Mental Health and Drug and Alcohol Office, NSW Health, Discipline of Psychiatry, Sydney Medical School, University of Sydney, and School of Population Health, University of Queensland, Brisbane, Queensland; Philip M. Burgess, MA, PhD, School of Population Health, Queensland Centre for Mental Health Research, University of Queensland, Brisbane, Queensland; Gin S. Malhi, MBChB, BSc, MD, FRCPsych, FRANZCP, Discipline of Psychiatry, Sydney Medical School, University of Sydney, Royal North Shore Hospital, and CADE Clinic, Department of Academic Psychiatry, Royal North Shore Hospital, Sydney, New South Wales; Harvey A. Whiteford, MB BS, MPH, MD, FRANZCP, Queensland Centre for Mental Health Research, University of Queensland, Brisbane, Queensland; Wayne C. Hall, MSc, PhD, Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
| | - Wayne C Hall
- Grant E. Sara, MB BS, MM, MM (Psychotherapy), FRANZCP, InforMH, Mental Health and Drug and Alcohol Office, NSW Health, Discipline of Psychiatry, Sydney Medical School, University of Sydney, and School of Population Health, University of Queensland, Brisbane, Queensland; Philip M. Burgess, MA, PhD, School of Population Health, Queensland Centre for Mental Health Research, University of Queensland, Brisbane, Queensland; Gin S. Malhi, MBChB, BSc, MD, FRCPsych, FRANZCP, Discipline of Psychiatry, Sydney Medical School, University of Sydney, Royal North Shore Hospital, and CADE Clinic, Department of Academic Psychiatry, Royal North Shore Hospital, Sydney, New South Wales; Harvey A. Whiteford, MB BS, MPH, MD, FRANZCP, Queensland Centre for Mental Health Research, University of Queensland, Brisbane, Queensland; Wayne C. Hall, MSc, PhD, Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
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Addington J, Case N, Saleem MM, Auther AM, Cornblatt BA, Cadenhead KS. Substance use in clinical high risk for psychosis: a review of the literature. Early Interv Psychiatry 2014; 8:104-12. [PMID: 24224849 PMCID: PMC4356483 DOI: 10.1111/eip.12100] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 09/22/2013] [Indexed: 11/29/2022]
Abstract
AIM In the literature, there is evidence suggesting an association between substance use and psychosis. However, little is known about substance use in those who may be in the pre-psychotic phase, that is, those who are putatively prodromal are considered to be at clinical high risk (CHR) of developing psychosis. METHODS We conducted a review of publications measuring patterns and rates of substance use in CHR for psychosis individuals and the effects on the transition to psychosis. RESULTS Of 5527 potentially relevant research papers, 10 met inclusion criteria of CHR subjects and specifically mentioned substance use in the sample. The results of these studies varied. Cannabis, alcohol and tobacco/nicotine were reported as the most commonly used substances. There was limited information on the changes in patterns of use over time. Two out of the ten studies found a significant association between the use of substances and subsequent transition to psychosis. In one of these studies, substance abuse was a predictor of psychosis when included as a variable in a prediction algorithm. In the other study, the abuse of cannabis and nicotine was associated with transition to psychosis. CONCLUSIONS We found limited evidence to suggest that increased rates of substance use may be associated with transition to psychosis. However, further prospective research examining the association between substance use and transition to psychosis is required before any firm conclusions can be made.
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Affiliation(s)
- Jean Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Nevicia Case
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Majid M. Saleem
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Andrea M. Auther
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks
| | - Barbara A. Cornblatt
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks
- The Feinstein Institute for Medical Research, Manhasset, New York
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The impact of substance use at psychosis onset on First Episode Psychosis course: results from a 1 year follow-up study in Bologna. Schizophr Res 2014; 153:60-3. [PMID: 24525084 DOI: 10.1016/j.schres.2014.01.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 12/09/2013] [Accepted: 01/10/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Substance abuse is a well established risk factor for First-Episode Psychosis (FEP), but its influence on FEP course is less clear. Starting from our baseline observation that substance users were younger than non-users at the psychosis onset, we hypothesized that substance use at baseline could be an independent risk factor for a worse clinical course. METHODS An incidence cohort of patients with FEP collected in an 8year period (2002-2009) at the Bologna West Community Mental Health Centers (CMHCs) was assessed at baseline and at 12month follow-up. Drop-out, hospitalizations and service utilization were used as clinical outcomes. RESULTS Most of the patients were still in contact with CMHC at 12month follow up. Substance users had a significantly higher rate of hospitalizations during the follow-up after adjusting for age, gender and other potential confounders (OR 5.84, 95% CI 2.44-13.97, p≤0.001). CONCLUSIONS This study adds to previous evidence showing the independent effect of substance use on FEP course. The identification of a "potentially modifiable" environmental predictor of the course of the illness such as substance use at psychosis onset allows us to envisage the possibility of ameliorating the course of the illness by managing this factor.
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Lange EH, Nesvåg R, Ringen PA, Hartberg CB, Haukvik UK, Andreassen OA, Melle I, Agartz I. One year follow-up of alcohol and illicit substance use in first-episode psychosis: does gender matter? Compr Psychiatry 2014; 55:274-82. [PMID: 24262129 DOI: 10.1016/j.comppsych.2013.08.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 07/05/2013] [Accepted: 08/04/2013] [Indexed: 11/19/2022] Open
Abstract
Longitudinal studies on first-episode psychosis (FEP) patients have shown a decrease of substance use disorders (SUDs) over the first years of illness, but there has been less focus on the gender aspect. The present study examines stability of alcohol and illicit substance use, with specific focus on gender, in a one year follow-up investigation of 154 FEP patients (91 men, 63 women) in Oslo, Norway, using criteria for DSM-IV substance use disorder diagnosis, the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT). The results show that cannabis was the most frequently used illicit substance at both times. Significantly more men (34%) than women (13%) had a current illicit SUD at baseline. At follow-up, the rate of illicit SUDs was significantly reduced in men (18%) but not in women (11%). There were no significant gender differences in the rate of current alcohol use disorders (AUD) (men 14%; women 8%) at baseline, and no significant reduction in AUD in any of the genders at follow-up. At follow-up, total AUDIT and DUDIT scores were reduced in men only. In conclusion, the high and persistent rate of SUDs, particularly of cannabis, among men and women during the first year of treatment for psychosis should be addressed in the clinical management of the patients. Female FEP patients who are also substance users may be particularly vulnerable in this regard and warrant closer attention.
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Affiliation(s)
- Elisabeth Heffermehl Lange
- KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Psychiatry Section, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway.
| | - Ragnar Nesvåg
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Petter Andreas Ringen
- KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Psychiatry Section, University of Oslo, Oslo, Norway; KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Cecilie Bhandari Hartberg
- KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Psychiatry Section, University of Oslo, Oslo, Norway; Department of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - Unn Kristin Haukvik
- KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Psychiatry Section, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Ole Andreas Andreassen
- KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Psychiatry Section, University of Oslo, Oslo, Norway; KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingrid Melle
- KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Psychiatry Section, University of Oslo, Oslo, Norway; KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingrid Agartz
- KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Psychiatry Section, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
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Zipursky RB, Menezes NM, Streiner DL. Risk of symptom recurrence with medication discontinuation in first-episode psychosis: a systematic review. Schizophr Res 2014; 152:408-14. [PMID: 23972821 DOI: 10.1016/j.schres.2013.08.001] [Citation(s) in RCA: 142] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 07/29/2013] [Accepted: 08/01/2013] [Indexed: 11/28/2022]
Abstract
The large majority of individuals with a first episode of schizophrenia will experience a remission of symptoms within their first year of treatment. It is not clear how long treatment with antipsychotic medications should be continued in this situation. The possibility that a percentage of patients may not require ongoing treatment and may be unnecessarily exposed to the long-term risks of antipsychotic medications has led to the development of a number of studies to address this question. We carried out a systematic review to determine the risk of experiencing a recurrence of psychotic symptoms in individuals who have discontinued antipsychotic medications after achieving symptomatic remission from a first episode of non-affective psychosis (FEP). Six studies were identified that met our criteria and these reported a weighted mean one-year recurrence rate of 77% following discontinuation of antipsychotic medication. By two years, the risk of recurrence had increased to over 90%. By comparison, we estimated the one-year recurrence rate for patients who continued antipsychotic medication to be 3%. These findings suggest that in the absence of uncertainty about the diagnosis or concerns about the contribution of medication side effects to problems with health or functioning, a trial off of antipsychotic medications is associated with a very high risk of symptom recurrence and should thus not be recommended.
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Affiliation(s)
- Robert B Zipursky
- Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, Ontario L8N 3K7, Canada.
| | - Natasja M Menezes
- Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, Ontario L8N 3K7, Canada.
| | - David L Streiner
- Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, Ontario L8N 3K7, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Manchanda R, Chue P, Malla A, Tibbo P, Roy MA, Williams R, Iyer S, Lutgens D, Banks N. Long-acting injectable antipsychotics: evidence of effectiveness and use. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:5S-13S. [PMID: 23945067 DOI: 10.1177/088740341305805s02] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To review the evidence for the role of long-acting injectable (LAI) antipsychotics (APs), especially the second-generation AP (SGA) LAIs, in the treatment of schizophrenia and to discuss the use rates of LAIs in Canada. METHOD A search of online medical databases was conducted of the published literature (1995-2012) of the effects of LAIs on the domains of remission, adherence, relapse, and hospitalization. Results obtained from randomized controlled trials (RCTs), systematic reviews, meta-analyses, and large-scale observational studies were included. Expert consensus data were also solicited on LAI use within a Canadian context. RESULTS While the efficacy of LAIs, compared with placebo, is well established, the evidence from RCTs is equivocal for any specific advantage for SGA LAIs, compared with oral medications, probably owing to challenges in conducting such RCTs. Evidence from methodologically less rigorous studies and from clinical practice suggests some advantages in achieving and maintaining remission, risk of relapse, and hospitalization. The rate of LAI (first-generation AP and SGA) use from published outpatient studies is low at 6.3% in Canada, compared with 15% to 80% worldwide. However, there is a relatively high rate of use in specific early psychosis programs and in conjunction with community treatment orders in Canada. CONCLUSIONS LAIs are at least as effective as oral APs in the treatment of psychotic disorders. The former may have specific advantages for patients who demonstrate covert nonadherence. The underuse of LAIs in Canada needs to be better understood and addressed.
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Affiliation(s)
- Rahul Manchanda
- Professor, Department of Psychiatry, Western University, London, Ontario; Director, Prevention and Early Intervention Program for Psychoses, London Health Sciences Centre, London, Ontario.
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Batalla A, Garcia-Rizo C, Castellví P, Fernandez-Egea E, Yücel M, Parellada E, Kirkpatrick B, Martin-Santos R, Bernardo M. Screening for substance use disorders in first-episode psychosis: implications for readmission. Schizophr Res 2013; 146:125-31. [PMID: 23517662 PMCID: PMC4390132 DOI: 10.1016/j.schres.2013.02.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 02/05/2013] [Accepted: 02/24/2013] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Screening of substance use may prove useful to prevent readmission after the first episode of psychosis. The aim of the present study was to evaluate the influence of drug use on readmission risk in a first-episode psychosis sample, and to determine whether the cannabis/cocaine subscale of the Dartmouth Assessment of Lifestyle Inventory (DALI) is a better predictive instrument than urinary analysis. METHODS After admission, first-episode psychotic patients were interviewed for substance use and assessed with the DALI scale. They also underwent blood and urine sampling. Time to readmission was studied as a dependent outcome. The Kaplan-Meier estimator was applied to estimate the survival curves for bivariate analysis. The Cox proportional hazards model for multivariate analysis was assessed in order to control for potential confounders. ROC curve and validity parameters were used to assess validity to detect readmission. RESULTS Fifty-eight patients were included. The DALI cannabis/cocaine subscale and urinalysis were associated with increased readmission risk in survival curves, mainly the first five years of follow-up. After controlling for potential confounding variables for readmission, only the DALI cannabis/cocaine subscale remained as a significant risk factor. In terms of validity, the DALI cannabis/cocaine subscale was more sensitive than urinalysis. Alcohol assessments were not related to readmission. CONCLUSIONS The findings demonstrated that a quick screening self-report scale for cannabis/cocaine use disorders is superior to urinary analysis for predicting readmission. Future research should consider longitudinal assessments of brief validated screening tests in order to evaluate their benefits in preventing early readmission in first-episode psychosis.
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Affiliation(s)
- Albert Batalla
- Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer, Centro de Investigación Biomédica en Red en Salud Mental, 08036 Barcelona, Spain.
| | - Clemente Garcia-Rizo
- Schizophrenia Program, Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, IDIBAPS, CIBERSAM, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Pere Castellví
- Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Spain, Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), and CIBER Epidemiología y Salud Pública (CIBERESP), Doctor Aiguader 88, 08033, Barcelona, Spain, CIBER Epidemiología y Salud Pública (CIBERESP), Doctor Aiguader 88, 08033, Barcelona, Spain
| | - Emili Fernandez-Egea
- Good Outcome Schizophrenia Clinic, Cambridgeshire and Peterborough NHS Foundation Trust, UK, Department of Psychiatry and Behavioural and Clinical Neuroscience Institute (BCNI), University of Cambridge, Forvie Site, Cambridge CB2 0SZ, UK
| | - Murat Yücel
- School of Psychology and Psychiatry, Monash University, Clayton Campus, Melbourne, Victoria 3800, Australia
| | - Eduard Parellada
- Schizophrenia Program, Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, IDIBAPS, CIBERSAM, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Brian Kirkpatrick
- Department of Psychiatry, Texas A&M University College of Medicine, Scott & White Healthcare, 1901 South Veterans Memorial Drive, 76504, Temple, TX, United States
| | - Rocío Martin-Santos
- Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Spain, Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Miguel Bernardo
- Schizophrenia Program, Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, IDIBAPS, CIBERSAM, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
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Faridi K, Joober R, Malla A. Medication adherence mediates the impact of sustained cannabis use on symptom levels in first-episode psychosis. Schizophr Res 2012; 141:78-82. [PMID: 22910403 DOI: 10.1016/j.schres.2012.07.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 07/18/2012] [Accepted: 07/20/2012] [Indexed: 11/26/2022]
Abstract
Both medication non-adherence and co-morbid cannabis abuse are associated with poor clinical outcome in first episode psychosis (FEP). The nature of interaction between adherence to medication and continued cannabis use remains unexplored. The objectives of this study were to examine variation in medication adherence associated with cessation or continuation of cannabis use, and to determine the impact of interaction between cannabis use and adherence to medication on symptom outcome at 12 months. From a consecutive patient cohort (N=192) with a DSM-IV diagnosis of a FEP, 62 patients who met DSM-IV criteria for a currently active cannabis abuse disorder were followed up for one year. Complete data on repeated measures of medication adherence, symptoms, and cannabis use were available for 48 of the 62 patients. Twenty-eight patients (58.7%) continued while 20 (41.2%) stopped cannabis use after entering treatment. While both groups were relatively non-adherent at six months, 25/28 (92%) of the former group became adherent compared to 8/20 (40%) of those who stopped cannabis use (p<.01). While there was no overall effect of continued cannabis use on symptom levels at 12 months, after controlling for medication adherence patients with continuous cannabis use had significantly higher level of symptoms (F(1,30)=2.74, p=0.03). FEP patients with an active cannabis use disorder may make a choice of either stopping cannabis and not taking medications or continuing cannabis but becoming more adherent to medications, adherence to medication appears to help both groups but continuous users remain at higher risk of poor symptom outcome even while on medication.
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Affiliation(s)
- Kia Faridi
- Prevention and Early Intervention Program for Psychosis, Montreal, Quebec, Canada
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Caseiro O, Pérez-Iglesias R, Mata I, Martínez-Garcia O, Pelayo-Terán JM, Tabares-Seisdedos R, Ortiz-García de la Foz V, Vázquez-Barquero JL, Crespo-Facorro B. Predicting relapse after a first episode of non-affective psychosis: a three-year follow-up study. J Psychiatr Res 2012; 46:1099-105. [PMID: 22721546 DOI: 10.1016/j.jpsychires.2012.05.001] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 05/02/2012] [Accepted: 05/03/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Preventing relapse during the first years of illness has a critical impact on lifelong outcomes in schizophrenia. A better understanding and improvement in factors which influence relapse should diminish the risk of relapse and consequently improve the outcome of the illness. OBJECTIVE To identify factors associated with relapse after 3 years of a first episode in a sample of non-affective psychosis patients who are representative of clinical practice in an epidemiological catchment. METHOD We analyzed socio-demographic and clinical data from a cohort of patients who were treated in a specialized early intervention service and who were at risk of relapse during a 3-year follow-up. Univariate analyses, logistic regression and survival analyses were performed. The analyzed variables included gender, age at onset, duration of untreated psychosis, clinical severity at baseline, insight at baseline, premorbid functioning, substance use, family history of psychosis and adherence to medication. RESULTS Of the 140 patients considered to be at risk for relapse, 91 (65%) individuals relapsed at least once over the three-year period. The relapse rates at 1 year and 2 years were 20.7% and 40.7%, respectively. Adherence to medication was the only significant predictor of relapse after a three-year follow-up [hazard ratio (HR) 4.8, 95% confidence interval (CI) 2.9-7.7; p < 0.001]. Comparison of the mean time of relapse between adherent and non-adherent patients also revealed statistically significant differences (933 and 568 days, respectively). 50% of patients will relapse despite being categorized as treatment adherents. CONCLUSION Non-adherence to medication is the biggest predictive factor of relapse after a first episode of psychosis.
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Affiliation(s)
- Olalla Caseiro
- Marqués de Valdecilla University Hospital, IFIMAV, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain.
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Risk factors for relapse following treatment for first episode psychosis: a systematic review and meta-analysis of longitudinal studies. Schizophr Res 2012; 139:116-28. [PMID: 22658527 DOI: 10.1016/j.schres.2012.05.007] [Citation(s) in RCA: 306] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 04/04/2012] [Accepted: 05/05/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Preventing relapse is an essential element of early intervention in psychosis, but relevant risk factors and precise relapse rates remain to be clarified. The aim of this study was to systematically compile and analyse risk factors for and rates of relapse in the early course of psychosis. METHODS Systematic review and meta-analysis of English and non-English language, peer-reviewed, longitudinal studies, with a minimum 12-month follow-up and at least 80% of participants diagnosed with a first episode of psychosis (FEP) that reported risk factors for relapse. RESULTS Of 153 potentially relevant articles, 29 were included in the study. Pooled prevalence of relapse of positive symptoms was 28% (range=12-47%), 43% (35-54%), 54% (40-63%) at 1, 1.5-2, and 3 years follow-up, in that order. A total of 109 predictors were analysed, with 24 being assessed in at least 3 studies. Of those, 20 predictors could be extracted for meta-analysis. Medication non-adherence, persistent substance use disorder, carers' critical comments (but not overall expressed emotion) and poorer premorbid adjustment, increased the risk for relapse 4-fold, 3-fold, 2.3-fold and 2.2-fold, respectively. CONCLUSIONS Clinical variables and general demographic variables have little impact on relapse rates. Conversely, non-adherence with medication, persistent substance use disorder, carers' criticism and poorer premorbid adjustment significantly increase the risk for relapse in FEP. Future studies need to address the methodological limitations of the extant research (e.g. definition of relapse), focus on the identification of protective factors and evaluate theoretically derived models of relapse.
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Mourao-Miranda J, Reinders AATS, Rocha-Rego V, Lappin J, Rondina J, Morgan C, Morgan KD, Fearon P, Jones PB, Doody GA, Murray RM, Kapur S, Dazzan P. Individualized prediction of illness course at the first psychotic episode: a support vector machine MRI study. Psychol Med 2012; 42:1037-47. [PMID: 22059690 PMCID: PMC3315786 DOI: 10.1017/s0033291711002005] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 08/17/2011] [Accepted: 08/22/2011] [Indexed: 01/02/2023]
Abstract
BACKGROUND To date, magnetic resonance imaging (MRI) has made little impact on the diagnosis and monitoring of psychoses in individual patients. In this study, we used a support vector machine (SVM) whole-brain classification approach to predict future illness course at the individual level from MRI data obtained at the first psychotic episode. METHOD One hundred patients at their first psychotic episode and 91 healthy controls had an MRI scan. Patients were re-evaluated 6.2 years (s.d.=2.3) later, and were classified as having a continuous, episodic or intermediate illness course. Twenty-eight subjects with a continuous course were compared with 28 patients with an episodic course and with 28 healthy controls. We trained each SVM classifier independently for the following contrasts: continuous versus episodic, continuous versus healthy controls, and episodic versus healthy controls. RESULTS At baseline, patients with a continuous course were already distinguishable, with significance above chance level, from both patients with an episodic course (p=0.004, sensitivity=71, specificity=68) and healthy individuals (p=0.01, sensitivity=71, specificity=61). Patients with an episodic course could not be distinguished from healthy individuals. When patients with an intermediate outcome were classified according to the discriminating pattern episodic versus continuous, 74% of those who did not develop other episodes were classified as episodic, and 65% of those who did develop further episodes were classified as continuous (p=0.035). CONCLUSIONS We provide preliminary evidence of MRI application in the individualized prediction of future illness course, using a simple and automated SVM pipeline. When replicated and validated in larger groups, this could enable targeted clinical decisions based on imaging data.
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Affiliation(s)
- J. Mourao-Miranda
- Centre for Neuroimaging Sciences, Institute of Psychiatry, King's College London, UK
- Centre for Computational Statistics and Machine Learning, UCL, London, UK
| | - A. A. T. S. Reinders
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
- Department of Neuroscience, University Medical Center Groningen, and BCN Neuroimaging Center, University of Groningen, The Netherlands
| | - V. Rocha-Rego
- Centre for Neuroimaging Sciences, Institute of Psychiatry, King's College London, UK
| | - J. Lappin
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
| | - J. Rondina
- Centre for Neuroimaging Sciences, Institute of Psychiatry, King's College London, UK
| | - C. Morgan
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
| | - K. D. Morgan
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
| | - P. Fearon
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
| | - P. B. Jones
- Department of Psychiatry, University of Cambridge, UK
| | - G. A. Doody
- Division of Psychiatry, University of Nottingham, UK
| | - R. M. Murray
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
| | - S. Kapur
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
| | - P. Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
- NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King's College London, UK
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Ouellet-Plamondon C, Abdel-Baki A. Jeune, urbain… mais psychotique : l’importance du travail de proximité. ACTA ACUST UNITED AC 2012; 36:33-51. [DOI: 10.7202/1008589ar] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
La psychose débutante non traitée occasionne beaucoup de souffrance et son impact se répercute à divers degrés sur le fonctionnement de la personne atteinte. Lorsqu’elle survient dans un milieu de centre-ville, un défi supplémentaire s’impose puisque plusieurs jeunes vivent dans des conditions précaires, instables et sont désaffiliés. Il faut adapter l’organisation des soins pour éviter un retard dans l’identification et le traitement de la psychose. Cet article présente différentes pistes de solution en décrivant la Clinique JAP du CHUM, clinique d’intervention précoce pour la psychose, qui offre des services intégrés visant à optimiser l’évolution. Pour favoriser l’adhésion au traitement, il importe d’offrir un climat accueillant et convivial, d’avoir un cadre d’intervention flexible et de faire preuve d’un espoir optimiste mais réaliste. Des interventions intensives offertes par une équipe interdisciplinaire spécialisée, en collaboration avec les différents acteurs communautaires, doivent être mises en place de façon proactive afin d’abréger le délai du traitement et d’éviter des conséquences désastreuses de la psychose.
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Affiliation(s)
| | - Amal Abdel-Baki
- M.D., FRCPC, M. Sc., Psychiatre à la Clinique Jeunes Adultes Psychotiques (JAP) du CHUM
- Chef du Programme des troubles psychotiques, Centre hospitalier de l’Université de Montréal — Hôpital Notre-Dame
- Chercheur investigateur, Centre de recherche CHUM
- Professeure agrégée de clinique, Département de psychiatrie, Université de Montréal
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Levy E, Pawliuk N, Joober R, Abadi S, Malla A. Medication-adherent first-episode psychosis patients also relapse: why? CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2012; 57:78-84. [PMID: 22340147 DOI: 10.1177/070674371205700204] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Poor adherence to medication is a major determinant of relapse following treatment of first-episode psychosis (FEP). However, medication-adherent patients also relapse. We examined what factors influence the risk of relapse after controlling for adherence. METHOD We selected a sample of fully adherent patients (n = 65) who had achieved remission at one point. We then compared patients who relapsed, using 2 different definitions of relapse, to those who did not relapse by 12 months on age, sex, premorbid adjustment, duration of untreated psychosis, length of prodrome, and substance abuse. RESULTS Among the 65 medication-adherent patients in remission, 9 (14%) relapsed according to criteria for relapse requiring a change in medication. These patients differed from those who remained in remission only in the pattern of premorbid adjustment (greater proportion with deteriorating pattern), although this was not independent of other variables. No differences were found on any other variable. Using a more commonly used metric for relapse, based on symptom ratings alone, an additional 14 (21.5%) patients relapsed. Substance abuse significantly predicted relapse, with substance abusers having more than 25 times the odds of relapsing by 12 months (OR 25.6; 95% CI 2.4 to 278.1, P = 0.008). CONCLUSION Using a more conservative definition of relapse in this adherent-to-medication population, we find a very low rate of relapse associated, at least partially, with poor premorbid adjustment. As substance abuse was a significant predictor of symptomatic relapse, this would suggest that there should be a greater emphasis on interventions focused on reducing substance abuse in FEP.
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Affiliation(s)
- Emmanuelle Levy
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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Gender differences in service use in a sample of people with schizophrenia and other psychoses. SCHIZOPHRENIA RESEARCH AND TREATMENT 2012; 2012:365452. [PMID: 22966434 PMCID: PMC3420527 DOI: 10.1155/2012/365452] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 01/28/2012] [Indexed: 11/18/2022]
Abstract
Objective. The main objective is to analyze the use of mental health services in a sample of people with schizophrenia and other psychoses according to gender. Method. The sample of this observational and retrospective study (n = 7483) consisted of all the persons who visited any mental health service of the Parc Sanitari Sant Joan de Déu from 2001 to 2007 with a diagnosis of schizophrenia and other psychoses. The main measures analyzed regarding gender were the frequency of patients for each diagnosis, their risk of being admitted into hospital, and the number and length of hospitalizations for the subsample of inpatient people during the study period. Results. Men are more frequent in the total sample (58.1%). For diagnosis of schizoaffective or delusional disorder, women have a higher frequency than men. Women with diagnosis of schizophrenia have a lower risk of being admitted to the hospital (RR = 0.84, 95% CI (0.72, 0.97)). We found a higher risk of longer stays for men with schizophrenia of the disorganized type (RR = 0.49, 95% CI (0.30, 0.81)), undifferentiated (RR = 0.41, 95% CI (0.27, 0.61)), or delusional disorder (RR = 0.65, 95% CI (0.49, 0.87)). Conclusion. Gender of patients is a relevant variable in mental health service use by patients with schizophrenia and other psychoses.
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50
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Relapse prevention and remission attainment in first-episode non-affective psychosis. A randomized, controlled 1-year follow-up comparison of haloperidol, risperidone and olanzapine. J Psychiatr Res 2011; 45:763-9. [PMID: 21106207 DOI: 10.1016/j.jpsychires.2010.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 09/28/2010] [Accepted: 11/03/2010] [Indexed: 11/21/2022]
Abstract
The effectiveness of antipsychotics in preventing relapses and attaining symptomatic remission is a relevant topic of psychopharmacological research. The purpose of the present study was to compare the relapse and symptomatic remission rates during the first year of treatment between low doses of haloperidol and SGAs (olanzapine and risperidone) in drug-naïve first-episode non-affective psychosis individuals. This is a prospective, randomized, open-label study conducted from February 2001 to February 2006. Data for the present investigation were obtained from a large epidemiologic and 3-year longitudinal intervention program of first-episode psychosis (DSM-IV criteria) conducted at the University Hospital Marques de Valdecilla, Santander, Spain. One hundred and seventy four patients were randomly assigned to haloperidol (N = 56), olanzapine (N = 55), or risperidone (N = 63) and followed up for 1 year. Primary effectiveness measures were the time up to relapse and rates of relapse and symptomatic remission. There were no significant differences in the relapse rate between treatments (11.1% haloperidol; 18.5% olanzapine, and 13.8% risperidone) (χ(2) = 1.230; p = 0.541) or in the time up to relapse (Log Rank χ(2) = 0.308; p = 0.857). The rates of relapse for adherent (11.2%) and non-adherent (26.9%) patients were significantly different (χ(2) = 4.215; df = 1; p = 0.040). The remission rate did not differ significantly between treatment groups (χ(2) = 2.760; p = 0.252) and adherence to medication did not seem to significantly influence remission rates. We conclude that haloperidol, olanzapine and risperidone show a similar effectiveness in relapse prevention or in remission attainment during the first year of treatment.
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